2009 ECONOMIC AND SOCIAL COUNCIL ANNUAL MINISTERIAL REVIEW HIV in Latin America and the Caribbean Implementing agreed goals and commitments César Antonio Núñez - UNAIDS Montego Bay, Jamaica, 5-6 June 2009

Halfway between UNGASS (2001) and the Millennium Development Goals (2015) HIV in Latin America and The Caribbean

HIV epidemic in Latin America remains stable overall, but continues growing in vulnerable groups. In 2007, new infections were estimated at [88 000– ] Estimated number of PLWHIV is 1.7 millones Of total PLWHIV, 44,000 are under 15 años Approximately 63,000 individuals died of AIDS in Overall figures – LA

HIV Prevalence remains high among Men who have Sex with Men, Male Sex Workers, Female Sex Workers, Crack Cocaine Users, Prisoners, and Young People In 2007, 20, 000 New HIV Infections occurred Total of 230,00 people living with HIV from 210,000 in 2001 Adult HIV prevalence at 1.1% and increasingly affecting females 14,000 people died of AIDS: leading cause of death in the years-old Overall figures – Caribbean

HIV prevalence in Latin American & Caribbean adults, 1990−2007

end end end end Millions Year end end North Africa and the Middle East Eastern Europe and Central Asia East, South and South-East Asia Latin America and the Caribbean Sub-Saharan Africa Number of people receiving antiretroviral drugs in low- and middle income countries, 2002−2007

Geographical Region Est. # receiving ART Dec 2007 Est. # needing ART Dec 2007 ART Coverage Dec 2007 LAC390,000630,00062% Latin America360,000560,00064% Caribbean30,00070,00043% Universal Access Report 2007 WHO June Estimated # of individuals receiving ART, 2007

Number of HIV-infected children under 15 receiving antiretroviral treatment (2005–2006) There was a 56% increase in the number of children receiving ARVs in LAC

Monitoring the Epidemic: Resource Tracking Annual expenditures on HIV/AIDS in Latin America by source, Million US$ Domestic Public Expenditures Total International (Excluding GF) The Global Fund to fight AIDS, Tuberculosis, and Malaria División de Financiación y Economía del SIDA, ONUSIDA, 2008

Monitoring the Epidemic: Resource Tracking Annual expenditures on HIV/AIDS in the Caribbean by source, Million US$ Domestic Public Expenditures Total International (Excluding GF) The Global Fund to fight AIDS, Tuberculosis, and Malaria División de Financiación y Economía del SIDA, ONUSIDA, 2008

The Three Ones Principles Are we monitoring? ONE HIV/AIDS Action Framework ONE National AIDS Coordinating Authority ONE M&E System UNIVERSAL ACCESS

Gaps and challenges in the response to HIV

Under-addressed issues Quality and availability of relevant data  Reporting against the UNGASS and Universal Access, although improved, is not without notable gaps. HIV, social vulnerability and risk-taking behaviours:  Women and HIV  Men who have sex with men (MSM) and transgenders  Sex workers (SW)  Injecting drug users:

‘Scratching the surface’ of integrated development programming While the interconnectedness among MDGs is clear, it is not always evident that the correlation of development issues finds its way into cohesive, multisectoral development programming and measurement. Failure to routinely integrate strategies and services to address undeniably interconnected issues represents a lost opportunity.

Care, Treatment and Support Further integration into primary health care services Further integration of community care/support services Geographic decentralization of treatment sites Equity in treatment access Close Gaps in coverage Mind treatment costs

Stigma and Discrimination “... In most countries, discrimination remains legal against women, men who have sex with men, sex workers, drug users and ethnic minorities. This must change.... [I]n countries with legal protection and protection of human rights for these people..., there are fewer deaths. Not only is it unethical not to protect these groups: it makes no sense from a public health perspective. It hurts us all.” Ban Ki-moon UN Secretary General – August 2008

Institutional Response Monitoring and evaluation Availability of resources Integrated Public Health Delivery Systems

The Way Forward: Meeting the Internationally Agreed Development Goals (IADGs)

Maintaining interest in HIV Continue to provide community, national and regional leadership and to keep HIV on national and regional agenda Maintain and/or increase, as far as possible, current national investments in HIV (with a focus on integrated development approaches). Stronger and more visible national leadership on difficult challenges such as stigma

Maintaining strategic investment in HIV Improved data Right allocation of current and future investments: Strengthening of Health Systems Human rights and social justice programming Strengthening programs to address social vulnerability and risk:  Gender inequity  Most-at-risk populations Prevention: increasing coverage and comprehensiveness. Improving and enhancing collaborative responses for HIV/TB co-infection

Scaling up HIV Prevention For each new person put on ART, two new persons become HIV+ Combination HIV prevention programmes must be widely implemented at country and regional levels  Biomedical interventions (ABC, Circumcision, STI prevention...)  Education programmes, including sexuality education in youth  Enabling environment interventions based on human rights  Legislations to stop all forms of criminalization related to HIV  Creating a movement of social change  Expanding access to treatment as a contribution to prevention

Take-home messages Significant progress – but is it enough? Prevention is lagging behind and needs strengthening Increasing progress on civil society involvement Stigma and discrimination remain huge challenges Sustainability of funding Lack of strategic information Strengthen political will