20:20 Vision Making new and old money work better 20:20 Vision Making new and old money work better! Getting the Money We Need The Case for Investment and Using Resources for Maximum Impact Friday 22 July, 11:00 - 12:30 Kevin Osborne Director of HIV Programmes and Advocacy International AIDS Society

If you had R10,000 in your back pocket and you wanted to spend it on HIV: What would you spend it on? Why?

Today’s HIV reality Political commitment to HIV “Ending AIDS” rhetoric Graduation from low- to middle-income status Competing global priorities Donor fatigue Journey (full circle): 2 investment areas 2 methods 2 repurposing

Paradigm shift Global mechanisms (PEPFAR, Global Fund) Domestic resources Donor assistance models Journey (full circle): 2 investment areas 2 methods 2 repurposing Reference: Funders Concerned About AIDS, Philanthropic support to address HIV/AIDS in 2014 (2015)

Approaches Increase allocative efficiency Reduce management and procurement costs Improve procurement of supplies and services Increase allocative efficiency Journey (full circle): 2 investment areas 2 methods 2 repurposing

20:20 ǀ Priority areas Key populations Scientific advancements Journey (full circle): 2 investment areas 2 methods 2 repurposing

1. Key populations People who inject drugs, sex workers, men who have sex with men, and transgender people Focus on key populations within and across various HIV epidemic scenarios Challenge laws, policies and practices that stigmatize and discriminate Increase investment in civil society and community lead responses Reference: International AIDS Society, The Second Durban Declaration (2016)

1. Key populations Reference: David Wilson, Investing in HIV Prevention, LINKAGES Rights in Action (2015)

2. Scientific advancements Ensure access to antiretroviral therapy for all people living with HIV Scale up modern combination HIV prevention packages Treat and manage co-infections and co-morbidities Amplify research efforts for a vaccine and a cure Optimize implementation research Reference: International AIDS Society, The Second Durban Declaration (2016)

2. Scientific advances Focus on prevention Voluntary Medical Male Circumcision ART-based prevention Cash transfers Structural barriers Criminalization of HIV non-disclosure, exposure and transmission Criminalization of homosexuality, sex work and drug use

20:20 ǀ Meaningful methods Getting to communities Partnerships Journey (full circle): 2 investment areas 2 methods 2 repurposing

1. Getting to communities Global mechanisms’ difficulty reaching communities Community-led service delivery WHO recommends three overarching strategies that can improve service delivery: (1) integration, (2) decentralization and (3) task shifting. The community and community-led and community-based approaches are integral to these strategies, particularly for key populations. Reference: WHO Consolidated Guidelines on HIV Prevention, Diagnosis, Treatment and Care for Key Populations (2014) & UNAIDS, Communities Deliver (2015)

2. Partnerships “It takes a whole village to raise a child” Partnerships across silos Public-private partnerships and others Necessity of industry’s involvement in the HIV response “There must be a partnership between business and the community – without that this battle will not be won.” Nelson Mandela, AIDS 2000

20:20 ǀ Repurposed plans Optimized allocation Service delivery Journey (full circle): 2 investment areas 2 methods 2 repurposing

1. Optimized allocation Reallocation from general population Example Reallocating prevention funds in Sudan (ART 12->24%, SW clients 4->10%, FSW 4->15%, MSM 2->6%) averted 19,000 infections Investing in the most effective approaches Increasing VMMC allocation in Zimbabwe from less than 1% to 8% of HIV spending (and expanding ART, PMTCT, BCC and condoms within budget) could reduce new infections by 30% Targeting geographic hot spots Geospatial mapping (PEPFAR) Reference: David Wilson, Investing in HIV Prevention, LINKAGES Rights in Action (2015)

2. Service delivery Differentiated care Integration Differentiated care is a responsive, client-centred approach that simplifies and adapts HIV services across the cascade, to better serve the needs of people living with HIV and reduce unnecessary burdens on the health system. Integration Family planning Maternal and child health Tuberculosis Hepatitis C Non-communicable diseases

Advocacy priorities AIDS is political AIDS is about politics

If you had R10,000 in your back pocket and you wanted to spend it on HIV: What would you spend it on? Why?