The HIV Response Where are we now? SAMU SUMMARIES JANUARY 2017 samumsf.org

This presentation To list the scale of the global epidemic and the response To list the global targets we are working towards To list MSF’s response to the HIV epidemic

Number Living with HIV By the end of 2015 36.7 million people (adults and children) are living with HIV 1.8 million of those infected are children and 52% of all those infected live in eastern and southern Africa 36.7 million living with HIV 1.8 million are children 19.0 million in East and Southern Africa

Number of PLWHIV in antiretroviral therapy By June 2016 it is estimated that 18.2 million people infected with HIV are receiving antiretroviral therapy. With the new guidance to treat all people living with HIV global coverage has now reached 49%

Antiretroviral Coverage by Region 2010-2015 Although the numbers on ART have increased significantly there remains wide variations in ART covergage according to region with the middle east , eastern europe and central asia and west and central africa lagging behind in their response Wide variation in coverage by region

Number of deaths from AIDS Despite the massive scale up of treatment with antiretroviral therapy there were still 1.1 million deaths attributed to AIDS , 110,000 in children and 43% in eastern and southern africa in 2015 1.1 million AIDS related deaths 110,000 AIDS related paediatric deaths 470,000 AIDS related deaths in east and southern Africa

Number of new HIV infections 2015 And 2.1 million new infections in 2015 , 150,000 of which were in children and 46% in eastern and southern africa 2.1 million new infections 150,000 new paediatric infections 960,000 new infections in east and southern Africa

The number of new infections decreased in eastern and southern africa New HIV infections 2010-2015 The number of new infections decreased in eastern and southern africa Increased in eastern europe and central asia Remained stable in all other regions Although the number of infections remains significantly higher in Africa the number of new infections has declined over the last 5 years This contrasts with eastern europe and central asia where there has been a significant rise in the number of new infections

Distribution of new infections by region 2014 Majority of new infections: Asia and Pacific, Latin America and Middle east and North Africa : majority in a combination of key populations Eastern Europe and Central Asia : majority PWID Africa : General Population Across the different geographical regions different subpopulations account for the majority of new infections For example in eastern europe and central asia the majority of new infections are occuring in people who inject drugs ( PWID) whilst across Africa the epidemic remains generalised with the majority of new infections occuring in the general population

So what are the current global targets ?

The UNAIDs Fast-Track Targets By 2020: Fewer than 500,000 new infections Fewer than 500,000 AIDS related deaths Zero discrimination By 2030 Fewer than 200,000 new infections Fewer than 200,000 AIDS related deaths Zero discrimination UNAIDS has set the global fast track targets – aiming by 2030 for fewer than 200,000 new infections ( 10x less than we currently achieved ) and fewer than 200,000 AIDS related deaths ( 5 x less than was seen in 2015 )

Global Treatment Targets 2000-2030 Global treatment targets have doubled every 5 years since 2000 and with the introduction of treat all will need to double again Global treatment targets have doubled every 5 years since 2000 and need to double again

The 4 “90” Targets 90% of people who know their HIV positive status are accessing treatment 90% of people receiving treatment have suppressed viral loads 90% of people living with HIV know their status 73% of all PLWHIV with suppressed viral loads 90% of all PLWHIV know their status 81% of all PLWHIV on treatment In addition to these fast track global targets the majority of countries have also adopted the UNAIDS 90-90-90 targets which address each step of the HIV continuum of care. The goal is that 90% of people living with HIV know their status , 90% of people who know their status are accessing treatment and 90% of those on treatment have suppressed viral loads Overall this equates to 73% of all people living with HIV A fourth 90 has also been added to address prevention services – stating that 90% of people have access to HIV combination prevention services 90% of people have access to HIV combination prevention and sexual and reproductive health services

The global 90-90-90 : 2015 The global estimates show that the biggest gap to be addressed is the first target – identifying all those who are living with HIV . To do this innovative strategies will be needed and are discussed in the testing resource section Source Global AIDS response progress reporting: (WHO/UNAIDS estimates )

The WHO guidelines To support the scale up to these global targets WHO has developed 4 key guidelines , HIV testing services ,the consolidated guidelines for the use of antiretroviral drugs for treating and preventing HIV infection, a guideline specifically for prevention diagnosis and treatment for key populations and guidance for strategic information. They are all available on the WHO website and are included in the relevant resource pages on the SAMU website

What about the resources needed for scale up ? In low and middle income countries: $19.2 billion estimated resources available for AIDS response 2014 $26.2 billion estimate of what is needed by 2020 to reach the fast track targets $19.3 billion peak investment needed in 2017 to achieve the 90-90-90 targets 7.3 billion needed for HIV prevention by 2020 57% of total investments in AIDS response are from domestic funds $7 billion gap in resources available in 2014 and what is needed by 2020 A massive increase in funding is required to meet these ambitious targets $26.2 billion is what is estimated to be needed by 2020 to reach the fast track targets with a 19.3 billion peak investment needed in 2017 Despite an increase in domestic funding to 57% there remains a $7 billion resource gap Calculated in 2016 based on 2015 programme data http://www.unaids.org/sites/default/files/media_asset/HIV_investments_Snapshot_en.pdf

Sources of International Funding Multilateral assistance: The Global Fund to Fight AIDS TB and Malaria, UNITAID and other UN agencies 2015 26% of HIV assistance ($1.9 billion) was provided through mutlilateral agencies The Global Fun is the worlds largets financier of HIV and AIDS In Sept 2016 the fifth replenishment saw donors commit $12.9 billion between 2017 and 2019 The USA is the largest donor to the Global Fund followed by the UK, France, Germany and Japan Bilateral Assistance The majority of donor government funding was distributed directly to recipient countries in 2015 (74%). ‘Bilateral’ funding fell by US$ 715 million on 2014 levels with the USA accounting for the majority of this fall (57%) One source of bilateral funding is the President's Emergency Plan for AIDS Relief (PEPFAR) Since 2003, PEPFAR has spent US$ 70 billion on programmes globally to combat HIV and AIDS, tuberculosis, malaria and other opportunistic infections. Where multilateral and bilateral funding from USA (66.4%), United Kingdom 13%,France 3.5%,Germany 2.7% , Netherlands 2.3% Since 2006, these five countries have accounted for roughly 80% of all HIV funding from donor governments International HIV funding has traditionally come through both multilateral agencies such as the global fund , UNITAID and other UN agencies and trough bilateral assistance. The largest bilateral funding source is PEPFAR the presidents emergency plan for AIDS relief which has spent to date $70 billion globally on the HIV response Overall the largest contributor to international funding has been the US followed by the UK France Germany and the Netherlands

Source of International Funding Private philanthropic organisations Provided US$ 618 million for global HIV and AIDS programmes in 2014 –Private philanthropic organisations provided US$ 618 million for global HIV and AIDS programmes in 2014 – an 8% increase on 2013 The Bill & Melinda Gates Foundation is the leading philanthropic funder of international HIV efforts. To date, the foundation has committed more than $3 billion in HIV grants to organisations around the world and has given an additional $1.6 billion to the Global Fund. Additional funding has also been made available through philanthropic organisation with the Bill and Melinda Gates foundation leading these efforts

Key Messages Of the 36.7 million people living with HIV globally just under half are accessing treatment Access to ARV treatment has significantly increased but there are wide variations across the geographical regions In most regions the number of new infections has remained stable or slightly decreased except for eastern europe and central asia Ambition global targets have been set aiming for 73% of all those living with HIV to have a suppressed viral load and 200,000 new infections by 2030 Despite a significant increase in domestic funding much of the repsonse continues to rely on the commitment of international donors through multi and bi-lateral funding mechanisms: Will this commitment be enough ? In summary great achievements have been made over the last decade with just under half of all people living with HIV now accessing treatment Despite this there remain large differences between coverage across the regions with west and central africa and eastern europe and central asia lagging behind. In addition eastern europe and central area is the only region to see an ongoing increase in the number of new infections UNAIDS has set ambitious global targets with the 90-90-90 targets aiming overall for 73% of all people living with HIV to have a suppressed viral load To reach where we are today has relied on a significant global and domestic commitment to fight the epidemic. The question remains will ongoing multi and bilateral funding mechanisms be able to contribute enough to reach the $26.2 billion needed by 2020.