Melbourne, 23 July IAS 2014 Fatiha Terki, WFP Critical enablers and synergies including nutrition

2 We will discuss… Investment framework The role of critical enablers How this apply to emergencies with an emphasis on nutrition. What is the role of WFP?

million people were living with HIV in 2013: SSA, especially southern Africa, has the highest global burden of HIV 70.8% Estimated number of people living with HIV (2012) and trends in the incidence of new infections from 2001 to 2012 by region 2014 UNAIDS Gap Report HIV infection: epidemiology, pathogenesis, treatment, and prevention. Gary Maartens, Connie Celum, Sharon R Lewin, Lancet Online June 5, S (14) Source: UNAIDS 2013 report. Using HIV as an entry point presents opportunities for collaboration and health system strengthening interventions that are FN sensitive

4 The world of HIV and AIDS has changed… 31 M in M in 2012 Globally, 12.9 M people had started antiretroviral therapy at the end of M added since 2010 (33% in SA) 2014 UNAIDS Gap Report HIV infection: epidemiology, pathogenesis, treatment, and prevention. Gary Maartens, Connie Celum, Sharon R Lewin, Lancet Online June 5, S (14) M in M in 2013 Children’s new infections decreased by 58% from (2002) to (2013). 2.3 M in M by M in 2013 Scale-up of treatment Increased prevalence people on ART are living longer Decreased incidence Reductions in heterosexual transmission PMTCT Scale up Decreased Mortality people on ART are living longer National investments have increased – Shared responsibilities and global solidarity 35% decrease since % decrease since 2001

5 -In line with the three zeros -Compilation and analysis of evidence of interventions proven to reduce HIV risk, transmission, morbidity, mortality -Models the investments required globally between 2011 and 2020 to revers the epidemic …requiring prioritized investment approaches such as the UNAIDS investment framework

6 UNAIDS investment framework focuses on high-impact and high-value strategies. UNAIDS World AIDS day report, 2011 UNAIDS/WHO The treatment 2.0 framework for action, 2011 Key elements of investment framework

7 The investment framework recognizes social protection under synergies with development sectors Source(s): Schwartlander et al., 2011 Lancet Reduce Risk Reduce the likelihood of transmission Reduce mortality and morbidity Critical Enablers – incl. nutrition support  PMTCT  Condom promotion and distribution  Key populations  Treatment care and support to PLWH  Male Circumcision  Behavior Change programmes Synergies With Development Sectors including social protection Basic Programme Activities

8 Critical enablers and development synergies are catalyzers for improved prevention, treatment care and support 1 2 UNDP, UNAIDS 2012 Understanding and acting on critical enablers and development synergies Programme 1 A B B Food and Nutrition Support Enabler for treatment care and support May reduce mortality and improve adherence and retention in care Government entities (National AIDS council and MoH) NGOs HIV-sensitive (HIV outcome is one of many objectives) HIV-specific (sole/primary objective is an HIV outcome) Development synergies Critical enablers 2 1

9 Development synergies - Why is social protection an important investment for HIV outcomes? Prevention: address the multiple social determinants of the epidemic – income inequalities, gender inequalities, social exclusion –and thus contribute to a reduction in new infections, Treatment: address demand side barriers to access HIV services with potential to improve prevention, treatment and care and support outcomes. Mitigation: mitigate the significant social and economic impacts of HIV and AIDS on households and individuals, UNDP, UNAIDS 2012 Understanding and acting on critical enablers and development synergies

10 Nutrition and food security play an important role in humanitarian responses and the HIV continuum of care Individual Health Systems Community ARTInfectionPre-ART HIV continuum of care in Humanitarian settings Demand and Supply Sides Testing Preparedness Expanded response 1234 Role of Nutrition and Food Security Minimum response Critical Enablers Synergies with Development Sectors Source(s): WFP analysis

11 WFP is the co-convening agency for HIV in humanitarian emergencies in the UNAIDS Division of Labour UNAIDS Division of labour, 2010

12 HIV Increased morbidity and mortality Potentially negative coping behaviour that increases likelihood of HIV transmission (e.g., unprotected, transactional sex) Food insecurity may prevent people from seeking a diagnosis and/or initiating and adhering to treatment Increased nutritional needs through metabolic changes Reduced appetite and ability to take food Reduced ability of body to absorb nutrients Reduced access to food due to morbidity/low productivity Food insecurity and malnutrition Close relationship between HIV and food insecurity and malnutrition Source(s): WFP analysis

13 Food and nutrition interventions Treatment outcomes Nutritional stabilization/recovery Access to treatment 1 2 Nutrition Assessment, Education, Counselling and support (NACS) Food supplements Household support Faster weight gain (rebuilding of body tissues that were lost) Increased strength of immune system Increased drug effectiveness Reduced morbidity Reduced mortality Reduced transmission Improved quality of life Increased treatment uptake Increased treatment adherence and retention in care Food and nutrition supports treatment success by (1) facilitating nutritional recovery and (2) access to treatment Source(s): WFP analysis

14 WFP has significant expertise in food and nutrition programmes in the context of HIV WFP supports 33 countries with HIV programmes Care and treatment: 68% Mitigation and safety nets: 32% ART adherence rates are over 80% in significant proportion 1 of programs Total HIV/TB beneficiaries receiving support in 2013: 1,324,097 HIV: 701,644 TB: 416,517 OVCs: 205,936 Technical advice to include F&N into HIV / AIDS national strategies, implementation plan, and protocols Technical advice to include F&N into funding proposals (e.g., GFATM) What is WFP’s role? Adviser to government on nutrition integration into HIV policies & programmes Implementer of own programmes in line with government policies (1)73% of programmes reporting ART adherence Source(s): WFP’s SRP Analysis – HIV and TB Programmes 2013 WFP is one of the few agencies working on demand side of HIV/TB, Nutrition, maternal and child health services during emergencies 12