1. Latin America/Caribbean State of the Art HIV/AIDS Part Deux Paul R. De Lay, M.D. Chief, HIV/AIDS Division Global Bureau USAID March 13, 2001

2. HIV/AIDS The Expanded Response Major Challenges/Issues –PMTCT –Condom supply –OVC –Care and Support

3. HIV/AIDS and Infectious Disease Funding FY 1993-2001 ($ millions)

4. FY 2000 LIFE Initiative: An additional $100 million for an Interagency USG program with USAID, CDC, and DoD Four Program Elements: Primary prevention Caring for children affected by AIDS Home and community based care and treatment Capacity and infrastructure development Evolution of the HIV/AIDS Rapid Response

5. FY 2001: USAID Receives $330 million for HIV/AIDS Expanded Response Elements target for 2007: Reduce HIV Prevalence rates among those 15-24 years of age by 50% in high prevalence countries Maintain prevalence below 1% among 15-49 year olds in low prevalence countries Evolution of the Rapid Response

6. Targets continued: Ensure that at least 25% of HIV/AIDS infected mothers in high prevalence countries have access to interventions to reduce HIV transmission to their infants Help local institutions provide basic care and support services to at least 25% of HIV infected persons and to provide community support services to at least 25% of children affected by AIDS in high prevalence countries Evolution of the HIV/AIDS Rapid Response

7. USAID is Scaling Up HIV/AIDS Activities è Three Country Designations: –Rapid Scale Up –Intensive Focus –Basic Programs Intensive Focus Countries (20) Rapid Scale Up Countries (4) HIV/AIDS Basic Programs Countries (25)

8. Basic Countries

9. Criteria for Rapid Scale-Up & Intensive Focus Countries The relative severity of the epidemic The magnitude of epidemic The impact on economic and social sectors Enabling environment The risk of a rapid increase in prevalence Availability of other sources of funding Return on investment Security and safety issues National Interest

10. Intensive Focus Countries AFRICA Ethiopia (LIFE) Ghana Malawi (LIFE) Mozambique (LIFE) Namibia Nigeria (LIFE) Rwanda (LIFE) Senegal (LIFE) South Africa (LIFE) Tanzania (LIFE) West Africa Region (LIFE) ANE India (LIFE) ANE Region LAC Brazil Caribbean Sub-Region E&E Russia

11. Rapid Scale-Up Cambodia Kenya (LIFE) Uganda (LIFE) Zambia (LIFE)

12. Rapid Scale-up Rapid Scale-up LIFE Intensive Focus Intensive Focus LIFE Basic Basic LIFE

13. USAID Funding for HIV/AIDS FY 2001 By Account

14. Estimating USG Resources for HIV/AIDS

15. Funding Distribution for HIV/AIDS by Bureau FY 2001 – CSD Account Only

16. Funding Distribution for HIV/AIDS by Program Type FY 2001 – CSD Account Only

17. FY 2001 Legislative Directives on USAID’s HIV/AIDS Funding

18. FY 2001 Authorization Directives

19. New Directions/Confronting Obstacles Commodities Human Capacity Development Faith Based Organizations Rapid Response to Unsolicited Proposals Increased emphasis on research –HIV vaccines –microbicides

20. The “Big” Technical Challenges Improved targeting PMTCT Condom supply Orphans and vulnerable children Care and support

23. Preventing Mother to Child HIV Transmission History –076 Study (1994) –Short course Thai AZT (1998) –Uganda Nevaripene (1999) Breast feeding

24. Countries Providing Access to ARV HIV Care Argentina Brazil Colombia Costa Rica Uruguay

25. The Cost of Care In Brazil, > 2/3 of pharmaceutical budget devoted to ARVs covering less than 20% of those infected. This $350 million is $20 million more than the annual USAID budget for HIV/AIDS Treating all 36 million infected persons would cost $36 billion at the lowest price frame ($1000/p/y)

26. Care: What Does It Involve: Complex regimens (2 nucleoside reverse transcriptase inhibitors and 1 protease inhibitor) Trained HCWs and minimal lab support Life long intervention (sustainable, role of drug donations) Misuse increases multi-drug resistance Need for prevention remains Equity of access ( most vulnerable, lottery, most productive, core transmitters, ability to pay)

27. Drug Access/Drug Prices Advocates Compulsory licensing Parallel importing Expanded definition of generics (CIPLA) Pharmaceuticals Drug donations Individual negotiations Merck announcement (Crixovan: $600/yr, Stocrin $500/yr)

28. Anti-retrovirals One year course DrugTrade Name ClassUS $LDC $ AbacavirZiagenNRTI AmprenivirAgenerasePI AZT+3TCCombivirNRTI$7093$730 DelaviridineRescriptorNon-NRTI DidanosineVidexNRTI EfavirenzSustiva/ Stocrin Non-NRTI$4730$500 IndinavirCrixivanPI$6016$600 Lamivudine (3TC) EpivirNRTI$3271$232 NevirapineViramuneNon-NRTI$3508$483 StavudineZeritNRTI$3589$252

29. The Future: New directions?: New technologies?: improved condoms, vaccines, microbicides, simpler treatments, better diagnostics Websites: www.synergyaids.com www.synergyaids.com www.census.gov