1. The PEPFAR Blueprint for an AIDS Free Generation Implications for Uganda’s response to HIV Alice Kayongo-Mutebi, Community Health Alliance Uganda 14 February 2013 Uganda’s 3 rd Health Journalism Conference Imperial Royale Hotel

2. Halting disease progression—people living successfully with HIV and accelerated declines in HIV incidence Quality disease control programs (decentralized, community owned, better linkage, better adherence) delivering less toxic, more durable, easier to take regimens Massive scale up of combination HIV prevention Leveraging dramatic prevention benefits of ART—including earlier initiation of treatment Improved vertical transmission prevention regimens (Option B+) Scaled up HIV counseling & testing Policies, laws and programs that defend, protect and promote human rights of people with HIV and those at greatest risk of infection Condoms Safe medical male circumcision Virtually no children born with HIV infection We have reached a crossroads: ending the AIDS crisis is possible through accelerated scale up of treatment and combination prevention

3. Will Uganda seize this opportunity?

4. Uganda’s HIV crisis: Uganda AIDS Indicator Survey 2011 Between 2005 and 2011: Overall increase in number of adults infected from 837,000 to 1.262 million Prevalence increase from 6.4% to 7.3% New infections increased from 98,000 to 124,000

5. Incidence reductions in 23 high burden countries, (sub Saharan Africa + Haiti) between 2001-2011

6. Prevalence among key populations “HIV Sero behavioral survey in fishing communities in Lake Victoria Basin, Uganda.” 2010, Opio, Muyongo et al. Prevention investments are not matching the drivers of new HIV infections in Uganda

7. GuanU U Uganda’s 2010 crisis in treatment enrollment 800 patients per day turned away Action only after pressure: 36,000 new treatment slots secured through advocacy While others were scaling up, Uganda was scaling back Huge missed prevention, treatment opportunity

8. U.S. Government launches a “Blueprint for an AIDS Free Generation” on World AIDS Day 2012 (see: www.pepfar.gov) “Scientific advances and their successful implementation have brought the world to a tipping point in the fight against AIDS. The United States believes that by making smart investments based on sound science, and a shared global responsibility, we can save millions of lives and achieve an AIDS-free generation.” – Sec. of State Hillary Clinton, Dec 1 2013 Definition of an AIDS-Free Generation: Virtually no children born with HIV infection Adults living successfully with HIV and accelerated declines in HIV incidence (halting new infections through sexual transmission)

9. What is it? A commitment by the US Government to invest in high impact HIV prevention and treatment in key countries in order to rapidly bring out a “tipping point” – the point at which more people are being initiated on HIV treatment than are becoming infected. It provides the roadmap for how the U.S. Government will work to help achieve an AIDS- free generation

10. U.S. Government launches a “Blueprint for an AIDS Free Generation” on World AIDS Day 2012 PEPFAR is major funder of the response against HIV worldwide Bold, ambitious ‘road map’ to achieve a generation free from HIV—through increased commitment from the US, implementing countries, and all partners Modeling in three high burden countries—Uganda’s epidemic represents an ‘off track’ response, while Kenya and Zambia’s data show massive progress in reaching increased service delivery targets Activists demanded the Blueprint, in order to ensure US government commitment increases and strengthens despite the fiscal crisis Will Uganda seize this opportunity?

11. Ending the AIDS crisis through accelerated scale up of treatment, combination prevention With acceleration, Zambia would be able to avert a total of over 126,000 HIV infections 2012-2016, compared to baseline. Combination prevention + earlier access to tx would avert 179,200 new HIV infections—a 57 percent decline in incidence—over a four-year period, with 118,000 additional deaths averted.

12. Ending the AIDS crisis through accelerated scale up of treatment, combination prevention Through scale up at CD4<350 Kenya could avert 222,600 new HIV infections and 159,900 by 2016 compared to baseline Through scale up at CD4<550, 333,300 new HIV infections and 258,000 AIDS-related deaths could be stopped by 2016

13. Ending the AIDS crisis through accelerated scale up of treatment, combination prevention Accelerated combination prevention and treatment coverage would result in 226,829 fewer infections by 2016, and more than 101,000 deaths. Through scale up at CD4<550 along with combination prevention, incidence would be reduced by about 60%

14. Spending more now expands coverage and reduces costs in the near term

15. What questions should we be asking? How are we taking the PEPFAR BluePrint forward? How is civil society being involved in the process beyond having meetings? How will PEPFAR achieve an AIDS free generation when its not challenging the Ministry’s speed? Why are we settling for weak service delivery models that are neglect community involvement?