1. 20:20 Vision Making new and old money work better
20:20 Vision Making new and old money work better! Getting the Money We Need The Case for Investment and Using Resources for Maximum Impact Friday 22 July, 11: :30 Kevin Osborne Director of HIV Programmes and Advocacy International AIDS Society

2. If you had R10,000 in your back pocket and you wanted to spend it on HIV: What would you spend it on? Why?

3. Today’s HIV reality Political commitment to HIV “Ending AIDS” rhetoric
Graduation from low- to middle-income status
Competing global priorities
Donor fatigue
Journey (full circle):
2 investment areas
2 methods
2 repurposing

4. Paradigm shift Global mechanisms (PEPFAR, Global Fund)
Domestic resources
Donor assistance models
Journey (full circle):
2 investment areas
2 methods
2 repurposing
Reference:
Funders Concerned About AIDS, Philanthropic support to address HIV/AIDS in 2014 (2015)

5. Approaches Increase allocative efficiency
Reduce management and procurement costs
Improve procurement of supplies and services
Increase allocative efficiency
Journey (full circle):
2 investment areas
2 methods
2 repurposing

6. 20:20 ǀ Priority areas Key populations Scientific advancements
Journey (full circle):
2 investment areas
2 methods
2 repurposing

7. 1. Key populations
People who inject drugs, sex workers, men who have sex with men, and transgender people
Focus on key populations within and across various HIV epidemic scenarios
Challenge laws, policies and practices that stigmatize and discriminate
Increase investment in civil society and community lead responses
Reference: International AIDS Society, The Second Durban Declaration (2016)

8. 1. Key populations
Reference: David Wilson, Investing in HIV Prevention, LINKAGES Rights in Action (2015)

9. 2. Scientific advancements
Ensure access to antiretroviral therapy for all people living with HIV
Scale up modern combination HIV prevention packages
Treat and manage co-infections and co-morbidities
Amplify research efforts for a vaccine and a cure
Optimize implementation research
Reference: International AIDS Society, The Second Durban Declaration (2016)

10. 2. Scientific advances Focus on prevention
Voluntary Medical Male Circumcision
ART-based prevention
Cash transfers
Structural barriers
Criminalization of HIV non-disclosure, exposure and transmission
Criminalization of homosexuality, sex work and drug use

11. 20:20 ǀ Meaningful methods Getting to communities Partnerships
Journey (full circle):
2 investment areas
2 methods
2 repurposing

12. 1. Getting to communities
Global mechanisms’ difficulty reaching communities
Community-led service delivery
WHO recommends three overarching strategies that can improve service delivery: (1) integration, (2) decentralization and (3) task shifting. The community and community-led and community-based approaches are integral to these strategies, particularly for key populations.
Reference: WHO Consolidated Guidelines on HIV Prevention, Diagnosis, Treatment and Care for Key Populations (2014) & UNAIDS, Communities Deliver (2015)

13. 2. Partnerships “It takes a whole village to raise a child”
Partnerships across silos
Public-private partnerships and others
Necessity of industry’s involvement in the HIV response
“There must be a partnership between business and the community – without that this battle will not be won.”
Nelson Mandela, AIDS 2000

14. 20:20 ǀ Repurposed plans Optimized allocation Service delivery
Journey (full circle):
2 investment areas
2 methods
2 repurposing

15. 1. Optimized allocation Reallocation from general population
Example
Reallocating prevention funds in Sudan (ART 12->24%, SW clients 4->10%, FSW 4->15%, MSM 2->6%) averted 19,000 infections
Investing in the most effective approaches
Increasing VMMC allocation in Zimbabwe from less than 1% to 8% of HIV spending (and expanding ART, PMTCT, BCC and condoms within budget) could reduce new infections by 30%
Targeting geographic hot spots
Geospatial mapping (PEPFAR)
Reference: David Wilson, Investing in HIV Prevention, LINKAGES Rights in Action (2015)

16. 2. Service delivery Differentiated care Integration
Differentiated care is a responsive, client-centred approach that simplifies and adapts HIV services across the cascade, to better serve the needs of people living with HIV and reduce unnecessary burdens on the health system.
Integration
Family planning
Maternal and child health
Tuberculosis
Hepatitis C
Non-communicable diseases

17. Advocacy priorities
AIDS is political
AIDS is about politics

18. If you had R10,000 in your back pocket and you wanted to spend it on HIV: What would you spend it on? Why?