HIV Therapy for the Developing World: A Global Health Challenge Harold W. Jaffe, MD Department of Public Health University of Oxford Oxford, UK

Adults and children estimated to be living with HIV 2006 Total: 39.5 ( ) million Western & Central Europe740,000 North Africa & Middle East460,000 Sub-Saharan Africa 24.7 million Eastern Europe & Central Asia 1.7 million South & South-East Asia 7.8 million Oceania81,000 North America 1.4 million Caribbean250,000 Latin America 1.7 million East Asia 750,000

Estimated adult and child deaths from AIDS 2006 Total: 2.9 (2.5 – 3.5) million Western & Central Europe12,000 North Africa & Middle East36,000 Sub-Saharan Africa 2.1 million Eastern Europe & Central Asia84,000 South & South-East Asia 590,000 Oceania4,000 North America18,000 Caribbean19,000 Latin America65,000 East Asia43,000

HIV prevalence (%) in adults in Africa, 2005

Estimated Annual GDP Loss Attributed to HIV/AIDS, Country Loss in US$ (millions) Botswana 270 South Africa 7,230 Swaziland 102 Zambia 127 Zimbabwe 638 International Labour Organisation, United Nations: HIV and Work: Global estimates, impact and response, 2004

Mortality and HAART Use Over Time HIV Outpatient Study, CDC, Patients on HAART Deaths per 100 PY

Daily Cost of Antiretroviral Drugs 3TC/d4T/Nevirapine SourceCost U.S. retail pharmacy 1 $39 Low-income countries (average) 2 $ The Medical Letter 2006;4:67 2 UNAIDS, April 2007

The President’s Emergency Plan for AIDS Relief Announced January 28, focus countries Goals: − Treat 2 million HIV- infected people − Prevent 7 million new HIV infections − Provide care for 10 million HIV-infected people and AIDS orphans Overall budget for global AIDS: $15 billion over 5 years ($10 billion new money)

ARV Therapy in Low and Middle Income Countries: December % of the total unmet need

Challenges in Implementing ARV Programs in Developing Countries Lack of knowledge of HIV infection status Need for new care models Lack of trained personnel Laboratory support Corruption/maintenance of supply chain

The Global Challenge of HIV/AIDS Unanswered Questions in the ARV era Can a prevention focus be maintained? What happens when ARV resistance emerges? Can ARV programs upgrade medical infrastructure? Will staff and resources be diverted from other critical programs? Can ARV programs be sustained?

Estimated total annual resources available for AIDS, 1996–2005 PEPFAR Source: Lancet, 2006; 368: 526– World Bank MAP Launch Signing of Declaration of Commitment on HIV/AIDS Global Fund ( US$ millions )