Towards an improved investment approach for an effective response to HIV Dr Bernhard Schwartländer UNAIDS

We have done a lot … Unprecedented scale up of services Decline in rate of new HIV infections in many countries More than 6.5 M on ART But we can do better Scale up to date guided by “commodity approach” Unsystematic prioritisation and investment Resources spread thinly across many parallel interventions Focus on discrete interventions rather than overall results leading to a fragmented response

A shift in paradigm Strategic investment based on prioritisation and driven by latest evidence

What can we achieve? Universal Access by 2015

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% > <50 CD4 Count (cells/ml) Coverage ART coverage in 2015 by CD4 count 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% > <50 CD4 Count (cells/ml) Coverage 13.1 million (health) CD million (T4P)

Reaching people with services: Examples for 2015 Coverage Condoms (discordant couples)60% Condoms (high risk pop)50% Sex work60% MSM programmes60% IDU programmes60% Million HIV testing320 ART15

Return on investment: More than 12 million infections averted

9 Annual number of AIDS deaths: Life years gained 29.4 million

What will it cost? What are the returns?

11 Resources needed for the investment framework

Economic cost and returns 2011 to 2020 Cost/Returns Total additional investment (over 10 years) US$46.5 Billion Future treatment need averted US$40 Billion Life years gained US$1,060 per life year gained

Conclusions Through a focused and committed approach we can turn this epidemic around With an upfront investment over the coming 5 years, we will be able to turn cost around Time to overcome the false dichotomy between prevention and treatment In line with the commitments and targets included in the Declaration of the HLM AIDS The Lancet Vol 377 June 11, Available online at