2009 ECONOMIC AND SOCIAL COUNCILANNUAL MINISTERIAL REVIEW

HIV in Latin America and the Caribbean

Implementing agreed goals and commitments

César Antonio Núñez - UNAIDS

Montego Bay, Jamaica, 5-6 June 2009

Halfway between UNGASS (2001) and the Millennium Development

Goals (2015)

HIV in Latin America and The Caribbean

HIV epidemic in Latin America remains stable overall, but continues growing in vulnerable groups.

In 2007, new infections were estimated at 140 000 [88 000–190 000]

Estimated number of PLWHIV is 1.7 millones

Of total PLWHIV, 44,000 are under 15 años

Approximately 63,000 individuals died of AIDS in 2007.

Overall figures – LA

HIV Prevalence remains high among Men who have Sex with Men, Male Sex Workers, Female Sex Workers, Crack Cocaine Users, Prisoners, and Young People

In 2007, 20, 000 New HIV Infections occurred

Total of 230,00 people living with HIV from 210,000 in 2001

Adult HIV prevalence at 1.1% and increasingly affecting females

14,000 people died of AIDS: leading cause of death in the 25-44 years-old

Overall figures – Caribbean

HIV prevalence in Latin American & Caribbean adults, 1990−2007

Estimated Adult HIV Prevalence in the Three Regions of the Americas. UNAIDS/WHO, 2007

1.1%

0.6%0.5%

0.00%

0.20%

0.40%

0.60%

0.80%

1.00%

1.20%

Prev

alenc

e

Caribbean North America Latin America

end-2002

end-2004

end-2003

end-2005

0.4

0.8

1.2

1.6

2.2

2.8

Mill

ion

s

Year

2.4

2.6

3.0

0.0

0.2

0.6

1.0

1.4

1.8

2.0

end-2007

end-2006

North Africa and the Middle East

Eastern Europe and Central Asia

East, South and South-East Asia

Latin America and the Caribbean

Sub-Saharan Africa

Number of people receiving antiretroviral drugs in low- and middle income countries, 2002−2007

Geographical Region

Est. # receiving ART Dec

2007

Est. # needing ART

Dec 2007

ART Coverage Dec 2007

LAC 390,000 630,000 62%

Latin America 360,000 560,000 64%

Caribbean 30,000 70,000 43%

Universal Access Report 2007 WHO June 2008.

Estimated # of individuals receiving ART, 2007

Number of HIV-infected children under 15 receiving antiretroviral treatment (2005–2006)

There was a 56% increase in the number

of children receiving ARVs

in LAC

Monitoring the Epidemic: Resource TrackingMonitoring the Epidemic: Resource Tracking Annual expenditures on HIV/AIDS in Latin Annual expenditures on HIV/AIDS in Latin

America by source, 2001-2006America by source, 2001-2006

Mill

ion

US

$

Domestic Public Expenditures

Total International (Excluding GF)

The Global Fund to fight AIDS, Tuberculosis, and Malaria

0

200

400

600

800

1000

1200

2001 2002 2003 2004 2005 2006

División de Financiación y Economía del SIDA, ONUSIDA, 2008

Monitoring the Epidemic: Resource Monitoring the Epidemic: Resource TrackingTracking

Annual expenditures on HIV/AIDS in the Annual expenditures on HIV/AIDS in the Caribbean by sourceCaribbean by source, 2001-2006, 2001-2006

Mill

ion

US

$

Domestic Public Expenditures

Total International (Excluding GF)

The Global Fund to fight AIDS, Tuberculosis, and Malaria

0

50

100

150

200

250

2001 2002 2003 2004 2005 2006

División de Financiación y Economía del SIDA, ONUSIDA, 2008

The Three Ones Principles

Are we monitoring?

ONE HIV/AIDS Action Framework

ONE National AIDS Coordinating Authority

ONE M&E System

UNIVERSAL ACCESS

Gaps and challenges in the response to HIV

Under-addressed issues

Quality and availability of relevant data Reporting against the UNGASS and Universal Access,

although improved, is not without notable gaps.

HIV, social vulnerability and risk-taking behaviours: Women and HIV Men who have sex with men (MSM) and transgenders Sex workers (SW) Injecting drug users:

‘Scratching the surface’ of integrated development programming While the interconnectedness among MDGs

is clear, it is not always evident that the correlation of development issues finds its way into cohesive, multisectoral development programming and measurement.

Failure to routinely integrate strategies and services to address undeniably interconnected issues represents a lost opportunity.

Care, Treatment and Support

Further integration into primary health care services

Further integration of community care/support services

Geographic decentralization of treatment sites

Equity in treatment access Close Gaps in coverage Mind treatment costs

Stigma and Discrimination

“ ... In most countries, discrimination remains legal against women, men who have sex with men, sex workers, drug users and ethnic minorities. This must change. ... [I]n countries with legal protection and protection of human rights for these people ..., there are fewer deaths. Not only is it unethical not to protect these groups: it makes no sense from a public health perspective. It hurts us all.”

Ban Ki-moon

UN Secretary General – August 2008

Institutional Response

Monitoring and evaluation

Availability of resources

Integrated Public Health Delivery Systems

The Way Forward:Meeting the Internationally Agreed Development Goals

(IADGs)

Maintaining interest in HIV

Continue to provide community, national and regional leadership and to keep HIV on national and regional agenda

Maintain and/or increase, as far as possible, current national investments in HIV (with a focus on integrated development approaches).

Stronger and more visible national leadership on difficult challenges such as stigma

Maintaining strategic investment in HIV Improved data Right allocation of current and future investments: Strengthening of Health Systems Human rights and social justice programming Strengthening programs to address social

vulnerability and risk: Gender inequity Most-at-risk populations

Prevention: increasing coverage and comprehensiveness.

Improving and enhancing collaborative responses for HIV/TB co-infection

Scaling up HIV Prevention

For each new person put on ART, two new persons become HIV+

Combination HIV prevention programmes must be widely implemented at country and regional levels Biomedical interventions (ABC, Circumcision, STI prevention...) Education programmes, including sexuality education in youth Enabling environment interventions based on human rights Legislations to stop all forms of criminalization related to HIV Creating a movement of social change Expanding access to treatment as a contribution to prevention

Take-home messages

Significant progress – but is it enough? Prevention is lagging behind and needs

strengthening Increasing progress on civil society involvement Stigma and discrimination remain huge challenges Sustainability of funding Lack of strategic information Strengthen political will