1. Dr. César Núñez ONUSIDA RST LA Global Health Sector Strategies for HIV, STI and Viral Hepatitis 14 April 2015

2. OBJECTIVES  Provoke a discussion on regional priorities  Determine what needs to be done differently in the response to achieve our ambitious aims for 2021  Inform the Global Consultation in Geneva, 23-24 April

3. Why a six-year Strategy?  Implements the Fast-Track initiative  Positions Strategy to again be seminal reference for 2016 HLM  Aligns with planning cycles of other funds and programmes, as mandated by the quadrennial comprehensive policy review  Reduces transaction costs

4. Parameters of Strategy Update  Extension of current Strategy  Retain zeros, strategic directions, goal architecture  Update to account for  Changing geopolitical and development context  Urgency to implement Fast-Track strategy  New evidence on who is being left behind in Gap Report  Getting granular—sub-national  Regional focus on priorities, ambitions and game-changers  Strategy will be developed in parallel with UBRAF

5. Other targets aim at reducing the number of new HIV infections per year to 500,000 by 2020 and to 200,000 by 2030 as well as reaching zero discrimination By 2020 By 2030

6. 6 1,2 million infections averted 700 thousands deaths averted

7. Consultation process in LA Consolidation and inform Geneva for meeting on 23-24 April High-level meeting webcast 24 March Subregional webex (Central America, Andean Region, Southern Cone) 17-19 March Regional UNAIDS and open regional webex 10 and 17 March Regional stakeholders meeting in Panama 26 February UCRG Meeting 23-24 February in Panama

8. REGIONAL CONSULTATION LATIN AMERICA – RESULTS

9. Trends to impact on HIV and the response ECONOMIC Fast economic growth ▼ oil prices Inequalities in MICs Contraction of international aid and low South-South cooperation Sustainability at risk CIVIL SOCIETY Increasingly effective participation Advocacy decreasing Weak links with gov’ts CIVIL SOCIETY Increasingly effective participation Advocacy decreasing Weak links with gov’ts SOCIAL Social protection policies in several countries Tensions between HR’s and multiculturalism Culturally-embedded machismo High violence and GBV International and internal economic migration Changes in drug use SOCIAL Social protection policies in several countries Tensions between HR’s and multiculturalism Culturally-embedded machismo High violence and GBV International and internal economic migration Changes in drug use HIV AND HEALTH SYSTEMS Higher life expectancy Adherence increasing Incidence in young people Limite discussion on combined prevention HIV AND HEALTH SYSTEMS Higher life expectancy Adherence increasing Incidence in young people Limite discussion on combined prevention POLICY Lack of high-level political commitment HIV fades in wider health agenda Conservative ideologies put achievements at risk Respect for LGBT rights but restrictions on sex work and drug use Structural barriers to key populations Decentralization process UNAIDS Strategy should place LA at core if meant to be global POLICY Lack of high-level political commitment HIV fades in wider health agenda Conservative ideologies put achievements at risk Respect for LGBT rights but restrictions on sex work and drug use Structural barriers to key populations Decentralization process UNAIDS Strategy should place LA at core if meant to be global

10. Achievements to build on ▲ access to ART. ▲ condom use. ▲ adherence. ▼ MTCT. Friendly services HIV/SHR integration VIH/TB collaboration M&E systems. Community systems. Recognition of the role of people with HIV and key populations Incipient HIV national budgets. South-South cooperation Rights- protective laws. CS advocacy. Rights- protective laws. CS advocacy.

11. CHALLENGESGAPS Appropriation of national response Lack of political commitment and intersectorality Universal ART, testing and adherence – rural and marginalized populations in services Weak health and community systems – Vertical programmes Granulating strategic informationReaching new actors (BRICS) Human rights-based regulationsParticipation of local and regional networks Using TRIPS exceptions – prices comparable among countries Identification and use of technologies for prevention and treatment Regional and sub-regional integration to strengthen cooperation and optimize resources Local and focused knowledge and action Overcome stigma and discrimination, homo- and transphobia, and harmful social gender norms Criminalization of HIV ART and commodities stock-outs

12. Populations left behind Children and adolescentsYouthTransgender, MSM and sex workersWomenPeople with HIVPrisonersDrug usersMigrantsIndigenous populations

13. Making treatment and diagnosis universal Making CS work sustainable Involvement of key populations in care Implementation of innovative prevention methodologies Enhance prevention in key populations Guarantee of sustainability with domestic resources Strengthening of civil society – government articulation Guarantee of respect for human rights Strengthening of political commitment at all levels Priority strategies Implementation of comprehensive approach to adherence Disaggregation of strategic information Renew leadership POLICIES SERVICES CIVIL SOCIETY Promotion of intersectorality, including social protection

14. Game-changers 1) Policy and law reform Political commitment – accountability Positioning of Latin America in the global response Legal barriers to testing in adolescents Criminalization of HIV and sexual behaviors Use of TRIPS exceptions Human rights violations – antidiscrimination laws Regulation of sex work 2) Funding Guarantee of sustainability South-South cooperation Monitoring of expense quality Public-private alliances 3) Resource allocation Funding for co-infections Resources to key populations PMTCT Resources to disaggregated strategic information Resources for sexual education 4) Partnerships Integration with sexual and reproductive health Intersectorality (Education, Labour, judiciary) 5) Services delivery Services for key populations Training of health personnel Universal access to services – barriers Service quality Easy access to testing Monitoring loss of patients Decentralization of services 6) Civil society Empowerment and articulation Strong advocacy Social audit 7) Science and innovation Access to new prevention technologies Anthropological studies and operational research 8) Link with other development efforts Multisectorality (education and labour) Social protection for people with HIV and key populations

15. What could/should the Joint UNAIDS Programme do? Review the Division of Labour to avoid competition and promote synergies. Support to significantly reduce new infections. The baseline must be known. Expand achievements in treatment. Test and treat. Reduce ARV prices using TRIPS regulations. Scale-up of programs for promotion of adherence. Recall the leading role of governments and the importance of accountability and responsibility in the protection of human rights. Strengthen systems for collection and dissemination of granulated strategic information.. Redesign health- and other systems integrate civil society in service provision.

16. THANK YOU For more information visit ONUSIDA Latina web page: http://www.onusida-latina.org/es/noticias/766-consulta.html