Towards an AIDS Free Generation

Transcription

1 Informal Board Meeting 18 January, 2011 Towards an AIDS Free Generation Craig McClure Chief, HIV and AIDS

2 Achieving an AIDS-Free Generation UNAIDS Getting to Zero UNICEF MTSP The Unite for Children, Unite against AIDS Campaign has two global targets for 2015: Reducing the number of newly infected infants by 90% Reducing new infections among young people by 50%

3 UNICEF s Mandate Firmly Embedded in UNAIDS Strategy

4 UNICEF s four HIV programme areas (the Four Ps ) - Preventing mother to child transmission of HIV - Paediatric HIV care and treatment - Preventing HIV infection among adolescents and young people - Protecting and supporting children affected by HIV and AIDS

5 P1: Prevention of Mother-to-Child Transmission of HIV P2: Paediatric Care and Treatment

6 The Global Plan Towards Elimination of New HIV Infections Among Children and Keeping Their Mothers Alive

7 The Global Picture, 2010 Global Sub-Saharan Africa Number of women living with HIV 16.8 million 13.8 million 82% Number of pregnant women with HIV in need of ARVs for PMTCT 1.48 million 1.37 million 93% Number of children living with HIV 3.4 million 3.1 million 91% Number of children newly infected with HIV 390, ,000 90% Number of children dying from HIV 250, ,000 92% Source: UNAIDS World AIDS Day Report, 2011; WHO, UNAIDS and UNICEF. Global HIV/AIDS Response: Epidemic Update and Health Sector Progress Towards Universal Access Progress Report 2011

8 Nearly 90% of New Infections Among Children Occur in 22 Countries PMTCT Priority Countries: Angola, Botswana, Burundi, Cameroon, Chad, Cote d Ivoire, Democratic Republic of Congo, Ethiopia, Ghana, India, Kenya, Lesotho, Malawi, Mozambique, Namibia, Nigeria, South Africa, Swaziland, United Republic of Tanzania, Uganda, Zambia, Zimbabwe (countries identified in the Global Plan on the Elimination of New Infections in Children and Keeping Their Mothers Alive) Source: Universal Access, 2011

9 Some Progress has Been Made, but Still Less than Half of Women Receive ARVs to Prevent Mother-to-Child Transmission 48% Source: UNAIDS Data Tables, 2011; Universal Access, 2011

10 The Continuum of Care in 22 PMTCT Priority Countries, ANC Maternal HIV Test Maternal ARVs Institutional Delivery Infant ARVs Infant HIV Test % of women % of pregnant women accessing 1 ANC visit tested for HIV * Median of 22 PMTCT priority countries % of PWLWH who received ARVs % of Institutional Deliveries % of Infants born to PWLWH receiving ARVs for PMTCT % of infants born to PWLWH receiving a virological test by two months of age Source: Global HIV/AIDS Response: Epidemic update and health sector progress towards Universal Access, 2011

11 Paediatric Care and Treatment In 2010 an estimated 456,000 children under 15 in need received antiretroviral treatment, an increase from only 75,000 in Despite progress, only 23% of the 2.02 million children currently estimated to be in need of ART are receiving it. We need to: identify children living with HIV early, provide them with timely access to testing, care and treatment document and follow their progress. Source: Universal Access, 2011

12 Number of Children on ART % of children tested for HIV early in life Treatment for Children has Increased, but at an Unacceptably Low Rate Number of children on ART, and percentage reported to have been tested for HIV in the first 2 months of life, % Children EID 25% 20% % % % % Source: Universal Access, 2011

13 P1 and P2: What has UNICEF Done? Technical support: Conducted gap analyses, developed national costed plans and addressed barriers and bottlenecks to scale-up. Monitoring: Collected and compiled progress data for Universal Access goals Partnerships: Collaborated with partners to utilize new HIV testing equipment to increase access and enable more timely results and get low-cost paediatric formulations to children who need it Research: Impact evaluations of PMTCT efforts in South Africa and Rwanda, demonstrating that efforts are starting to yield results towards eliminating new infections Early Infant Diagnosis: Expanded use of dried blood spot (DBS) technology, point-of-care infant HIV diagnosis, CD4 and viral point testing to simplify service delivery.

14 P1 and P2: What is UNICEF Going to Do? Focused technical Support: Coordinate and facilitate the provision of technical support to the 22 priority countries. Monitor: Track progress on implementation of Global Plan at national and decentralized levels (Level 3 monitoring) Leadership: Act as a global technical knowledge leader on emtct by strategically communicating best practices, and making the money work. Manage the Interagency Task Team (IATT), including tracking progress against its objectives set out in its annual work plans. Innovation: Continue to explore innovative ways to follow up and retain mothers and their infants in HIV services and secure their access to AIDS treatment, care and support

15 P3: Prevention of HIV infection among adolescents

16 An estimated 5 million young people aged were living with HIV in 2009, a 12 per cent reduction since 2001 Source: Opportunity and Crises, 2010

17 Young Key Affected Populations

18 Safe practices of young injecting drug users Variable progress made in ensuring access to condoms, HIV testing and harm reduction programmes across countries but all have missed the target.

19 Young female sex workers: Condom use and testing Substantial progress made against target in making sex work safer in Asia but still missing the mark.

20 P3: What has UNICEF done? Responding to the underground HIV epidemics in Eastern Europe and Central Asia Blame and Banishment report: outlining issues faced by marginalized and underserved populations in CEE/CIS Stock taking of global progress Updated Opportunities in Crisis Promoting behaviour change Supporting mass media that are popular with young people: TV drama Shuga (Kenya), Tribes and Embrace Me (Trinidad and Tobago), Passion for Life (Latin America Regional Initiative) Development of curriculum-based sexual health programmes: The International Technical Guidance on Sexuality Education 2009)

21 P3: What is UNICEF going to do? Strengthen leadership role as the co-convener in the area of young people and HIV Support countries in scaling up evidence-informed, high-impact interventions through the development of technical guidance (eg. HCT guidance for adolescents) while watching the space for new evidence/approach and support countries to adopt them Support the generation and dissemination of evidence on young people through expanded partnerships with researchers, implementing partners, and private sectors (CAPRISA, PEPFAR, MTV etc..)

22 P4: Protecting and Supporting Children Affected by HIV and AIDS

23 SIGNS OF PROGRESS TRENDS IN ORPHAN AND NON-ORPHAN SCHOOL ATTENDANCE RATIOS IN SELECTED COUNTRIES,

24 Signs of Progress: Percentage of children aged 0-17 years whose households caring for OVC received external support in subsaharan Africa, Less than 10% 10-15% 16-21% Greater than 21%

25 BUT Still need for more effective and accelerated response for CABA Community & faith-based organisations at the forefront of responding to affected children but often in isolation from government policy & services, small scale. Inadequate support reaching households with OVC: median 11% of households receive external support, 17 countries in East & Southern Africa have National Plans of Action for OVC but little scale up & not integrated with national development plans. Lead Ministries of CABA response have insufficient human, financial, & institutional capacity;

26 P4: What has UNICEF done? Country-level system strengthening: Children and AIDS Initiative (CARI) in 9 countries in ESAR Programming: Shift from small-scaled, project based support to more upstream, system strengthening approach, particularly around social protection system Monitoring: Review of global indicators for OVC to inform the revised UNGASS reporting process Redefining the concept of child vulnerability: household wealth consistently predict vulnerability for all ages Technical leadership and convening role: Global Partners Forum and the release of Taking evidence to impact

27 P4: What is UNICEF going to do? Leadership: co-convener on UNAIDS social protection working groups. Advocacy: to ensure that care, support and mitigation are not falling off the agenda in the context of diminishing resources Generate and disseminate better evidence on HIVsensitive social protection, children in residential care Develop policy and programme guidance that help countries to scale up social protection systems that are sensitive to the needs of children affected by AIDS

28 Funding Picture

29 Global Expenditures on HIV and AIDS International AIDS assistance disbursed from donor governments and UNICEF, (in billions) International UNICEF

30 1, : Global Expenditures by MTSP-Focus Areas (millions) 1,600 1,400 58% 1,200 1, % Exp + Rec 2006 Exp + Rec 2007 Exp + Rec 2008 Exp + Rec 2009 Exp + Rec YCS & Dev. Edu & Gender Equality HIV-AIDS & Children Child Protection Pol. Adv. & Children's Rights Source: UNICEF internal financial data

31 Investment Framework

32 Reduce Risk Reduce the likelihood of transmission Reduce mortality and morbidity Basic Programme Activities o o o o o o PMTCT Condom promotion and distribution Key populations Treatment care and support to PLWH Male Circumcision Behavior Change programmes Critical Enablers Synergies With Development Sectors

33 Policy & Practice Nutrition Emergency Protection Health Government Relations Media Private Sector Early Childhood Development Supply Evaluation Education

34 Partnerships

35 Unified Budget Results and Accountability Framework (UBRAF) UNAIDS Strategy and 2011 UN Political Declaration U B R A F Goals Impact indicators Outcomes Outcome indicators Outputs Output indicators deliverable deliverable deliverable Cosponsors and Secretariat Task teams and working groups Country activities Joint Teams & Joint Programmes of Support National responses

36 How does UNICEF work with the Global Fund?

37 Innovation: Technologies, Approaches and Putting What Works into Practice

38 Text Messaging to Improve Early Infant HIV Diagnostic Services UNICEF s Project Mwana in Zambia uses cell phone text messaging to relay infant HIV test results to parents, reducing turnaround times by 50% and having a great positive impact in rural areas

39 Other Technologies and Innovations Helping to Expand Access to HIV Services Co-packaging of PMTCT commodities Mother-baby pack in Lesotho Point-of-Care CD4 Machines In Zimbabwe, an assessment of POC at 14 sites demonstrated a significant increase in determining the number of HIV positive women who are eligible for treatment.

40 Innovation and Knowledge Management: Disseminating Key Information, Encouraging Virtual Collaboration, and Supporting Operations Research

41 Way Forward: High-Impact Equitable Investments Prevention of mother-to-child transmission of HIV HIV testing for infants, adolescents and pregnant women as a gateway to treatment and prevention Treatment Voluntary male medical circumcision in generalized epidemics Condoms Harm reduction for people who use drugs Support to households affected by HIV and AIDS

42 New vision new energy