“Getting to Zero” UNAIDS Strategy Dr. Paul De Lay, Deputy Executive Director, Programme UNAIDS

UNAIDS Strategy  Defines an aspirational vision for the future of the AIDS response  Outlines 10 concrete goals to guide the global response to HIV for the next five years and focus the work of the United Nations on HIV.

VISION ZERO NEW HIV INFECTIONS. ZERO DISCRIMINATION. ZERO AIDS-RELATED DEATHS.

Strategic Directions Catalysing the next phase of treatment, care & support  Access to effective treatment when people need it  Strong national & community systems  Access to care, support & social protection Revolutionizing HIV prevention  Political commitment to why people are getting infected  Communities demand transformative change  Resources directed to hotspots and what works Advancing human rights & gender equality  Protective social & legal environments enable access  Equitable service provision reaches people most in need  HIV-related needs and rights women and girls addressed

 Ten concrete medium-term milestones on road to long-term vision  Established to guide global response and Joint Programme  Ambitious – UNAIDS role to lead and inspire  Evolved from Outcome Framework priority area working groups  Capture areas where real progress is needed Goals for 2015 Concrete, ambitious yet achievable milestones

 Sexual transmission of HIV reduced by half, including among young people, men who have sex with men and transmission in the context of sex work  Vertical transmission of HIV eliminated and AIDS-related maternal deaths reduced by half  All new HIV infections prevented among people who use drugs  Universal access to antiretroviral therapy for people living with HIV who are eligible for treatment  TB deaths among people living with HIV reduced by half  People living with HIV and households affected by HIV are addressed in all national social protection strategies and have access to essential care and support  Countries with punitive laws and practices around HIV transmission, sex work, drug use or homosexuality that block effective responses reduced by half  HIV-related restrictions on entry, stay and residence eliminated in half of the countries that have such restrictions  Zero tolerance for gender-based violence  HIV-specific needs of women and girls addressed in at least half of all national HIV responses Revolutionise HIV prevention Catalyse the next phase of treatment, care and support Advance human rights and gender equality Goals for 2015

Transformation agenda  Focus – Directing resources to where they have most impact on the epidemic—to hotspots, interventions, countries  Efficiency – Reducing unit cost, innovative delivery systems, involving communities, integrating services  Partnership – Supporting country ownership and south-south cooperation, engaging communities and emerging economies  Enhancing mutual accountability through shared ownership  People centered  Country focused  Builds on Synergies Focus and efficiency to radically reduce new infections, catalyse treatment access and advance human rights and gender equality

All new HIV infections prevented among people who use drugs by 2015

9 Global estimates of the availability of sterile injecting equipment per person who uses drugs per year, Figure 3.5 Availability of sterile injecting equipment, 2010 Source: Mathers BM, Degenhardt L, Ali H, Wiessing L, Hickman M, Mattick R, et al. HIV prevention, treatment and care for people who inject drugs: A systematic review of global, regional and national coverage. The Lancet 2010;379:

Global availability of OST Source: Mathers et al HIV prevention, treatment and care for people who inject drugs: A systematic, review of global, regional and country level coverage Lancet 1 March 2010

 Methadone and buprenorphine—are effective in treating dependence on opioids. … Drug users who remain in treatment and receive sufficient doses of the medication, experience greater benefits, including protection against HIV infection. … high-risk countries should make such treatment widely available, where feasible.  Multi-component HIV prevention programs that include sterile needle and syringe access are effective in reducing drug related HIV risks such as needle and syringe sharing.  nations should take steps to better align law enforcement and public health approaches. Effective …

In the Ukraine needle and syringe programmes are estimated to cost less than $100 per HIV infection averted. In Australia the return on investment of a decade of needle and syringe programmes was estimated at one and a half billion US dollars. … and cost effective.

Getting to Zero

Bold Results for 2011 In 10 of the 20 countries where the epidemic is driven by unsafe drug use or where unsafe drug use threatens a new wave of HIV infections: 1.Regulations and policies will be implemented to support evidence- based harm reduction and drug dependence treatment services in relation to injecting drug use and non-injecting stimulant use. 2.Needle and syringe programmes will be extended to regularly reach 40% of people who inject drugs, and opioid substitution therapy will be extended to regularly reach 10% of people who inject opioids. 3.Uptake of antiretroviral therapy for people who use drugs and are living with HIV will double.

An agenda for efficiency and focus

The 2011 High Level Meeting will allow us to Review progress since 2001 Chart the way forward Renew resolve

The 2011 High-Level Meeting on AIDS comes at a pivotal moment in the history of the epidemic. Thirty years into the AIDS response, let us unite for universal access. Let us, once and for all, set the course for zero new HIV infections, zero discrimination, and zero AIDS- related deaths. UN Secretary General Ban Ki-moon