What Will it Take to Reach the Fast Track Prevention Targets? July 18, 2016, International AIDS Conference Karl L. Dehne, Chief Prevention, UNAIDS

Towards Global Prevention Plan GLOBAL PLAN TOWARDS THE ELIMINATION OF NEW HIV INFECTIONS AMONG CHILDREN BY 2015 AND KEEPING THEIR MOTHERS ALIVE

Trends in New Adult HIV Infections & 2020 Target 2020 and 2030 targets Source: UNAIDS 2016 New HIV infections among adults (15+) (million) 75%

6 Countries Accounted for about 50% of New HIV Infections Worldwide in 2015 COUNTRYNumber of new HIV infections South Africa Nigeria Russia Uganda India Mozambique75 000

30 countries accounted for over 80 % of new HIV infections in 2015 COUNTRYNumber of new HIV infectionsCOUNTRY Number of new HIV infections South Africa Malawi Nigeria Ethiopia… Russia Angola Uganda Côte d’Ivoire India Lesotho Mozambique Pakistan Kenya Ukraine Indonesia Vietnam China South Sudan Zimbabwe DR Congo Zambia Mexico USA Myanmar Tanzania Swaziland Brazil Ghana Cameroon40 000Colombia10 000

Distribution of new HIV infections among population groups, selected regions, 2014 Methodological note: Estimated numbers of new HIV infections by key population were compiled from country Spectrum files submitted in 2015 to UNAIDS (2014 data), available modes-of- transmission studies and additional sources of data drawn from GARPR reports. Where data were lacking, regional medians were calculated from available data and applied to countries’ populations.

5 Prevention Pillars

Core results for HIV prevention by 2020

Speed and scale South Africa- Number of people receiving ART, (in millions)

Kenya cumulative circumcisions, 2008–2011 (in thousands)

India-Number of female sex workers contacted through outreach, (in thousands) Source: Sex Trans Infect 2010; 86 (Suppl 1): i 76 – i 82. doi: /sti

KwaZulu Natal, South Africa- number of male condoms distributed (in millions) 2010/1 to 2014/5

A management framework for HIV prevention

Core capacities needed in a national HIV prevention management team

Call for Action National level Adjust national results frameworks to ensure 90% of key populations and priority groups in high-prevalence settings access combination prevention Strengthen national HIV prevention management systems Develop or adjust a mechanism for accountability Analyse determinants of prevention demand, uptake, and adherence Develop or adapt standard operating procedures, including health and community components that include aspect of demand, delivery and adherence Develop mechanisms for domestic financing of prevention Subnational level (district or city) Develop simple subnational implementation plans including operational targets for service delivery and demand generation Establish a dynamic implementation management group for HIV prevention Regular mentoring and monitoring visits, tracking and review of progress and bottlenecks Facility level Deliver effective prevention services as population-specific packages Strengthen provider approaches towards core results on condom distribution/promotion, PrEP, VMMC, ART Integrate prevention and treatment communication and service delivery Orient service providers on the right to prevention for everyone at risk

Community level Ensure community empowerment and participation in service delivery Accelerate integrated demand generation for core prevention outcomes, testing and treatment Streamline delivery system of community- based programs Global level Engage high-level politicians in priority countries & donors to ensure commitment to and investment in scaling and speeding up delivery of prevention programs Develop and promote a global plan to reduce new adult infections including a concise results framework Convene a global partnership including priority county leadership to agree on accountability mechanism Develop tracking mechanism e.g. scorecard for outcomes Convene global review meetings of priority countries in 2018 and 2020 Call for Action

Reaching the 2020 Fast-Track Prevention Targets is possible, but requires that we do business differently!