1. The transformational nature of the aids response Peter Piot,MD,PhD

2. A global view of HIV infection 33 million people [30–36 million] living with HIV, 2007 2.2

3. Number of people receiving ARV therapy in low- and middle-income countries, 2002—2007

4. Decline in adult mortality with introduction of ART: Botswana

5. HIV prevalence (%) among pregnant women attending antenatal clinics in sub-Saharan Africa, 1997–2007 NOTE: Analysis restricted to consistent surveillance sites for all countries except South Africa (by province) and Swaziland (by region) Southern Africa 0 10 20 30 40 Median HIV prevalence (%) 50 Botswana Lesotho Mozambique Namibia South Africa Swaziland Zimbabwe 1997– 1998 1999– 2000 2001200220032004200520062007 West Africa 0 5 10 15 20 Median HIV prevalence (%) 0 5 10 15 20 Median HIV prevalence (%) Eastern Africa 1997– 1998 1999– 2000 2001200220032004200520062007 1997– 1998 1999– 2000 2001200220032004200520062007 Ethiopia Kenya Burkina Faso Côte d'Ivoire Ghana Senegal 2.9 Source: National surveillance reports and UNAIDS/WHO/UNICEF, Epidemiological Fact Sheets on HIV and AIDS. July 2008.

6. Number and percentage of HIV-positive pregnant women receiving antiretroviral prophylaxis, 2004–2007 200420062005 Number of HIV-positive pregnant women receiving anti-retrovirals Year 400 000 500 000 600 000 0 100 000 200 000 300 000 % of HIV-positive pregnant women receiving anti-retrovirals 0 5 30 35 15 20 25 40 10 2007 Source: UNAIDS, UNICEF & WHO, 2008; data provided by countries. 4.13

7. AIDS IS NOT OVER

8. HIV prevalence (%) in adults (15–49) in Africa, 2007 2.8

9. HIV infections among men having sex with men in Asia

10. The aids response is transformational » Science and rights driven » Political approach » Focus on results for people » Prevention AND treatment » Multi-disciplinary, multi-sectoral » Community engagement » Global response

11. Good politics, bad politics: the experience of Aids PPiot, HLarson,SRussell. Am J Publ Health, 2007;97:1934

12. Recorded female deaths in South Africa and Brazil for ages 15-64 years Source: Nathan Geffen. Statistics South Africa and Instituto Brasileiro de Geografia e Estatistica. Brazil, 2004.South Africa, 1997.South Africa, 2004

13. Median percentage of population reached with HIV prevention services within the specified legal environment Sex workers (N=42) Injecting drug users (N=17) Men having sex with men (N=28) 0 20 40 60 80 100 Median percentage of population reached with HIV prevention services (UNGASS indicator 9) Countries reporting having non- discrimination laws/regulations with protection for this population Countries reporting NOT having non- discrimination laws/regulations with protection for this population Source: UNGASS Country Progress Reports 2008. 3.7

14. Treatment Action Campaign (TAC), South Africa

15. UN security Council Resolution 1308 (2000) on AIDS

16. [i] 1996-2005 data: Extracted from 2006 Report on the Global AIDS Epidemic (UNAIDS, 2006) [ii] 1986-1993 data: AIDS in the World II. Edited by Jonathan Mann and Daniel J. M. Tarantola (1996) Notes:[1] 1986-2000 figures are for international funds only [2] Domestic funds are included from 2001 onwards Total annual resources available for AIDS 1986‒2007 0 1000 2000 3000 4000 5000 6000 7000 8000 9000 US$ million 292 1623 8.3 billion Signing of Declaration of Commitment on HIV/AIDS, UNGASS ‘96‘97‘98‘99‘00‘01‘02‘03‘04‘051986‘87‘88‘89‘90‘91‘92‘93‘94‘95 Less than US$ 1 million 59 212 World Bank MAP launch Global Fund PEPFAR 257 UNAIDS Gates Foundation ‘062007 10 000 8.9 billion 10 billion

17. Resources available to HIV-related programmes by source and bilateral disbursements, 2006 G Sources: UNAIDS analysis based on OECD/DAC online database (last visited on May 6, 2008), Resource availability UNAIDS 2005, Funders Concerned About AIDS (FCAA), European HIV/AIDS Funders Group (EFG) for Philanthropic sector Bilateral disbursements to HIV-related programmes in 2006 Total Resource availability for HIV-related programmes in 2006 (US$ Billions) 2 5 8 6 7 0 1 3 4 9 10 UN (2%) GFATM (7%) Foundations (11%) Bilaterals (33%) Domestic Public and Private (46%) EC (0.5%) Canada 2% Belgium 1% Netherlands 3% Other DAC country members 1% Sweden 3% Spain 1% Norway 2% Australia 2% Germany 2% Ireland 3% United Kingdom 9% United States 71% (US$ Billions) Total resources available: US$8.9 BillionPercentage out of the total bilateral disbursements Total Bilateral disbursements 2006: US$ 2.9 Billion The organizational disbursements are different than commitments or obligations, as well as different from in-country expenditures

18. Disbursements for HIV per US$ 1 Million GDP, 2006 H Sources: UNAIDS and Kaiser Family Foundation analysis, June 2007; Global Fund to Fight AIDS, Tuberculosis and Malaria online data query May 2007; International Monetary Fund, World Economic Outlook Database, April 2007. Italy 4 Japan 24 Canada 50 Germany 60 France 93 United States 120 United Kingdom 328 Ireland 408 Sweden 462 Netherlands 521 0100200300400500600 US$

19. Prices (US$/year) of first-line antiretroviral regimen in Uganda: 1998-2003

20. Focus on results for people  Targets  Know your epidemic and the society  Monitor and evaluate  Invest in information systems

21. Know your epidemic

22. Number of HIV infections each year by route of transmission in Cambodia, 1988-2004 Source: Peerapatanapokin and Brown, using Asia Epidemic Model Number of new HIV infections each year by route of transmission in Cambodia, 1988-2004 (Source: Peerapatanapokin and Brown, using Asian Epidemic Model) 0 5000 10000 15000 20000 25000 30000 35000 40000 45000 19881989199019911992199319941995199619971998199920002001200220032004 Male clientsSex workersWife from husbandHusband from wifeMother to child

23. Impotence fears hit polio drive By Ashfaq Yusufzai BBC News, Peshawar Health officials in Pakistan say they have failed to immunise over 160,000 children against polio due to rumours the vaccine causes sexual impotence. Parents in parts of northern Pakistan told the BBC news website they feared an "American conspiracy" to cut the fertility of the next generation. At least 39 cases of polio were reported in 2006, 15 of them in the North West Frontier Province (NWFP) and the tribal areas in which only 20% of people are immunised. Worldwide 1,902 cases of polio were reported during the year, a recent WHO report said. A WHO meeting in Geneva last October heard that children paralysed by polio around the world were infected by viruses originating from Pakistan, Afghanistan, India and Nigeria. Radio rumours The main opposition to the drive in Pakistan came from local clerics who run illegal FM radio channels in many NWFP districts and the tribal areas, say officials. Amirullah Khan, a resident of NWFP's Swat district, quoted Maulana Fazlullah of a local FM channel as telling his listeners the vaccination drive was "a conspiracy of the Jews and Christians to stunt the population growth of Muslims".

24. The PREVENTION GAP Persons at risk with access to selected prevention interventions, 2006 Source: Global HIV Prevention: the access and funding gap. June 2007

25. Cost Effectiveness

26. A multi-disciplinary, multi-sectoral response Health outcomes determined by multiple factors and interventions Particularly key besides health: law, education, work place, trade, armed forces Need to expand resource base First genuine business engagement in health

27. Percentage of countries with sectors included in the national AIDS strategy and earmarked budgets 6.5 Source: UNGASS Country Progress Reports 2008. 0 20406080100 Public works Tourism Trade and industry Minerals and energy Agriculture Transportation Health Labour Military/police Sector included Earmarked budget present Percentage of countries (%), N=126

28. Community engagement From planning to implementation Makes or breaks programmes “Aids literacy” National Aids Councils and Global Fund Country Coordination Mechanisms Societal sustainability and resilience

29. TASO, Uganda

30. A global response Global public good and strategic issue Role of United Nations Global civil society and activism International financing Generation WE

32. New instruments for AIDS financing World Bank Multi-country AIDS Program (2000) Global Fund to Fight AIDS, TB and Malaria (2002) PEPFAR, (2003) Unitaid (2005) (PRODUCT) Red (2005) Debt2Health (2007)

33. Opportunities for global health  Increased funding (ODA and research)  Collateral benefits (TB,malaria, health systems)  Culture of accountability  Tiered pricing  Engagement of non-medical sectors  Boost to research  Major interest by young people  But: how long will the momentum last?

34. Total health ODA commitments, 2001-2006 US$ Billions

35. Increase in TB financing and new sputum positive cases detected and treated

36. Direct funding of health systems through Global Fund grants Amount (approximately) Commodities, Products, Drugs - $6.3-billion Health Systems - $4.9-billion Administration - $1.4-billion Other - $1.4-billion

38. Conclusions Science AND justice as basis for policy Nothing for the people without the people Genuine multi-disciplinarity in planning, research and implementation Prevention AND treatment Information for accountability and programming Think long term and invest in capacity