Contextual overview with reference to MDG Goal 6 and projection for Post-2015 10th Partnership Annual Conference Side Event Combating HIV and TB through a joint regional action Helsinki, Finland November 21, 2013 Anna Marzec-Boguslawska, MD; M.P.H. Agency of the Ministry of Health
P O S T - M D G H I G H L E V E L PA N E L R E P O R T W O R D C L O U D Wagstaff, 2013
I N N O VAT I O N S O F T H E A I D S R E S P O N S E source: UNAIDS/PCB (32)/13.4 Coalitions: demand for action driven by an innovative coalition of people living with HIV, civil society, governments, the scientific community, the private sector and development partners. Mobilization: broad-based social movements, fuelled by grassroots activism, fostered and, coupled with international political commitment resulting in unprecedented resource mobilization and access to HIV treatment. Governance: unique arrangements were established to engage affected communities in meaningful ways. These include multisectoral National AIDS Councils and Country Coordinating Mechanisms at the country level and at the global level, a dedicated funding instrument (The Global Fund to Fight AIDS, TB and Malaria) and the unique Joint Programme of the UN. Science: demand for treatment, as well as significant public and private investments influenced scientific advancement, including new medicines and technologies Social justice: pragmatic responses to overcome stigma, discrimination, and social inequality, including gender-related, to ensure access to services in the context of human rights and dignity.
FA C T S Globally, HIV is the sixth leading cause of adult mortality and the largest killer among women aged 15 49. Despite the overall decline in the number of people newly infected with HIV, 2.5 million people acquired HIV in 2011. The numbers of new cases are rising among others in Eastern Europe and Central Asia. Health systems in many countries remain fragile, and unable to provide the sustainability of HIV-related health services as well as the integration of services (HIV and TB). Meanwhile evidence suggests that the influx of AIDS investments has improved not only the delivery of HIV-related services but in many countries strengthened their health systems.
FA C T S The AIDS epidemic reflects a variety of social determinants. The human rights of people living with and at higher risk of HIV are not always protected. Universal access remains a dream for millions of people and faces serious technical, economic and political (and sometimes also ideological) challenges. ARV treatment coverage continues to lag (be much lower) for Europe, at 25% compared to 46 % globally. Coverage of HIV prevention and treatment remains inadequate for key populations at higher risk, and especially for young people. Female sex workers, men who have sex with men and people who inject drugs are estimated to be 13, 19 and 22 times more likely to be living with HIV than members of general population.
A C C E L E R AT I N G P R O G R E S S 1. Apply strategic investment approaches to planning, resource allocation and programming. 2. Vulnerable populations have to be taken seriously: we have to focus on responding to the needs of people living with HIV, young people, women and girls, sex workers, people who inject drugs, men who have sex with men, transgender people, prisoners, refugees and migrants. 3. Programmatic and scientific innovation, hallmarks of the AIDS response should be supported in a continuous way. 4. Movement towards more diversified sources and sustainable approaches to generate AIDS investments, 5. to reduce per-person treatment costs through improved programme management, reductions in the cost of antiretrovirals are also needed. 6. Strengthen alliances with human rights and gender equality movements, continue to work on the elimination of discrimination, violence and exclusion; and inclusive development. 7. Broaden the political space afforded to the AIDS movement at national, regional and global levels.
To reiterate political committment. To overcome the ideological and cultural barriers (MSM, sex workers, transgender people, migrants, etc) To ensure universal access to prevention, treatment, care and support, regardless of the eligibility criteria for ART. Be prepared that millions of people with HIV will need to have access to HIV testing and counselling to learn their serological status. To use limited financial resources in a better way. To work on improvement of legal environment in order to combat stigma, discrimination, lack of respect for those who are different. To improve the collection of high quality data to built on. The need to understand where the responsibility of health system starts and stops, but also where the responsibility of patients starts and stops.
HIV is an infectious disease that by means of right interventions, delivered within a human rights framework, can be controlled and possibly even eliminated. The renewed political committment is crucial for further development and the assurance of the new public health for this Region. Reversing the global HIV and TB epidemic is a key indicator of, and instrumental to progress in development. ART has considerable benefits: as treatment and as prevention of ongoing HIV and TB transmission, and it is likely that it will be increasingly considered a key element of combination prevention and as part of the solution to ending the HIV epidemic; ART is the strongest TB prevention intervention and reduces TB incidence by over 90% in some settings. TB &AIDS requires multisectoral action and integration of services.
References: Achieving an AIDS-free world: science and implementation www.thelancet.com Vol 382 November 2, 2013 1461 AIDS governance: best practices for a post-2015 world www.thelancet.com Vol 381 June 22, 2013 The end of AIDS: HIV infection as a chronic disease www.thelancet.com Vol 382 November 2, 2013 Controlling the HIV/AIDS epidemic: current status and global challengs Thorsten Demberg* and Marjorie Robert-Guroff, August2012, Volume3, Article 250:3; www.frontiersin.org Harnessing the Prevention Benefits of Antiretroviral Therapy to Address HIV and Tuberculosis Current HIV Research, 2011, 9, 355-366 355 1873-4251/11; Reuben Granich*,1, Ying-Ru Lo1, Amitabh B. Suthart et al, UNAIDS/PCB (32)/13.4 AIDS, health and human rights: Toward the end of AIDS in the Post-2015 Development Era; UNAIDS, January 2013 Maximizing Impact and Return on Investments in STD/HIV Prevention Programs, David Wilson, Global HIV/AIDS Program Director, World Bank, IUSTI 2013, VIENNA
Thank you for your attention! a.marzec@aids.gov.pl