Turning the tide of HIV
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What will it take to turn the tide? Bernhard Schwartländer ogan Pillay ill Baernighausen resentation to the International AIDS Conference ashington D.C. uly 2012
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Presentation by Bernhard Schwartländer, Director of Evidence, Innovation and Policy at UNAIDS, to the International AIDS Conference in Washington, D.C. in July 2012. Explores progress in getting to zero new HIV infections, zero discrimination and zero AIDS-related deaths, and notes the need for continued investment and options for generating that investment. As he concludes: together we will end AIDS!
Transcript of Turning the tide of HIV
What will it take to turn the tide?
Bernhard SchwartländerYogan PillayTill Baernighausen
Presentation to the International AIDS ConferenceWashington D.C.July 2012
Doing it better
New
HIV
infe
ctio
ns (
mill
ions
)
Schwartländer et al. Lancet 2011
Business as usual will lead to stagnation
2011 2012 2013 2014 2015 2016 2017 2018 2019 20200
5
10
15
20
25
0
1,000,000
2,000,000
3,000,000
4,000,000
HIV
inve
stm
ent U
S$
(bill
ions
)
Investment
2011 2012 2013 2014 2015 2016 2017 2018 2019 20200
5
10
15
20
25
0
1,000,000
2,000,000
3,000,000
4,000,000
Schwartländer et al. Lancet 2011
Business as usual will lead to stagnationH
IV in
vest
men
t US
$ (b
illio
ns)
New
HIV
infe
ctio
ns (
mill
ions
)Investment
New HIV Infections
2011 2012 2013 2014 2015 2016 2017 2018 2019 20200
5
10
15
20
25
0
1,000,000
2,000,000
3,000,000
4,000,000
Schwartländer et al. Lancet 2011
Better investments can achieve large gainsH
IV in
vest
men
t US
$ (b
illio
ns)
New
HIV
infe
ctio
ns (
mill
ions
)
2011 2012 2013 2014 2015 2016 2017 2018 2019 20200
5
10
15
20
25
0
1,000,000
2,000,000
3,000,000
4,000,000
Pay now or pay forever
Schwartländer et al. Lancet 2011
HIV
inve
stm
ent U
S$
(bill
ions
)
New
HIV
infe
ctio
ns (
mill
ions
)
2015 gap:US$ 7 billion
Source: UNAIDS
Value for money: doing the right thingsN
umbe
r of
new
HIV
infe
ctio
ns
300 000
-1980 1990 2000 2010
Russian Federation
Brazil
AIDS investment
Antiretroviral treatment
Value for money: doing things right
Source: UNAIDS, WHO 2012
16
14
12
10
8
6
4
2
-
7
6
5
4
3
2
1
-
AID
S R
eso
urc
es (
US
$ b
illio
n)
Mill
ion
s o
f p
eop
le o
n A
RT
2002 2003 2004 2005 2006 2007 2008 2009 2010 2011
AIDS Resources and Treatment scale-upAfrica 2002 – 2011:
Value for money: price reductionsU
S$/
ppy
0
700
TDF+FTC+EFV
TDF+FTC+NVP
TDF+3TC+EFV
ZDV+3TC+EFV
3TC+NVP+ZDV
- 60%
- 57%- 53% - 41%
- 15%
Median price of selected first-line regimens in low-income countries
Source: Global Price Reporting Mechanism, WHO 2012
20082011
New World
Economic growth is rapidly changing the world order
High income
Lower middle income
Upper middle income
Low income
2000
Source: IMF data, extrapolated 2017-2020
Economic growth is rapidly changing the world order
2001200020032002
High income
Lower middle income
Upper middle income
Low income
Source: IMF data, extrapolated 2017-2020
Economic growth is rapidly changing the world order
200120002003200220052004
High income
Lower middle income
Upper middle income
Low income
Source: IMF data, extrapolated 2017-2020
Economic growth is rapidly changing the world order
20012000200320022005200420072006
High income
Lower middle income
Upper middle income
Low income
Source: IMF data, extrapolated 2017-2020
Economic growth is rapidly changing the world order
2001200020032002200520042007200620092008
High income
Lower middle income
Upper middle income
Low income
Source: IMF data, extrapolated 2017-2020
Economic growth is rapidly changing the world order
200120002003200220052004200720062009200820112010
High income
Lower middle income
Upper middle income
Low income
Source: IMF data, extrapolated 2017-2020
Economic growth is rapidly changing the world order
20012000200320022005200420072006200920082011201020132012
High income
Lower middle income
Upper middle income
Low income
Source: IMF data, extrapolated 2017-2020
Economic growth is rapidly changing the world order
2001200020032002200520042007200620092008201120102013201220152014
High income
Lower middle income
Upper middle income
Low income
Source: IMF data, extrapolated 2017-2020
Economic growth is rapidly changing the world order
200120002003200220052004200720062009200820112010201320122015201420172016
High income
Lower middle income
Upper middle income
Low income
Source: IMF data, extrapolated 2017-2020
Economic growth is rapidly changing the world order
20012000200320022005200420072006200920082011201020132012201520142017201620192018
High income
Lower middle income
Upper middle income
Low income
Source: IMF data, extrapolated 2017-2020
Economic growth is rapidly changing the world order
200120002003200220052004200720062009200820112010201320122015201420172016201920182020
High income
Lower middle income
Upper middle income
Low income
Source: IMF data, extrapolated 2017-2020
The vast majority of people living with HIV will be in middle income countries
2000 2010 20200%
20%
40%
60%
80%
100%
70%
37%
13%
High
Upper middle
Lower middle
Low
Income category
Proportion of people living with HIV by country income category, 2000 - 2020
Source: UNAIDS, IMF 2012
Inequality persists despite strong income growth
0%
100%
200%
$0
$5,000
$10,000
Per capita GDP
20111996
Richest 20%of population
Poorest 20%
South Africa: GDP per capita1996-2011
Source: IMF
0%
100%
200%
Inequality persists despite strong income growth
Per capita GDP
20111996
Richest 20%
Poorest 20%
Share of national income held by:
South Africa: GDP per capita and income distribution1996-2011
Source: IMF, World Bank
Most people living with HIV will live where the wealth is concentrated
Source: McKinsey Institute, UNAIDS 2012
2 of every 3 people living with HIV will be living in urban areas by 2030
600 big cities in the world in 2025:
25% of the population 60% of the global wealth
New Resources
Grow to 15% of Gov Budget: plus US$ 640 billion
US$ 2 020 bn
Economic growth: plus US$ 670 billion by 2020US$ 1 380 bn
Health spending in 2012:US$ 710 billion
US$ 710 bn
Wealth for health: economic growth will benefit health budgets in low- and middle-income countries
Source: UNAIDS, WHO 2012
1% income tax levy earmarked for AIDS
US$
3.1billion
75% of an alcohol levy
US$
3.9 billion
Contributions from high-revenue enterprises
US$
2.4 billion
2% of public sector budgets earmarked
for AIDS
US$
2.4billion
Mobile phone levy
US$
2.0billion
Airline levy by all African
countries
US$
1.7billion
Source: Estimates for UNAIDS by Oxford Policy Management, 2012
Options for domestic HIV financing in Africa
Extending the annual airline levy to all OECD countries
US$
3 billion
Global portion of widely implemented
tobacco taxes (WHO)
US$
11 billion Global financial transaction tax
US$
150 billion
Issue diaspora bonds (1% of developing-country
migrants’ savings)
US$
4 billion
Global tax on shipping and aviation fuels
US$
64 billion
Sources: World Bank, UN, IMF, AfDB, WHO, International Food Policy Research Institute, Bill & Melinda Gates Foundation
Options for global development financing
Those that say it can’t be done should get out of the way of those doing it
Chinese Proverb
Together we can end AIDS
