1. The HIV Response Where are we now?
SAMU SUMMARIES JANUARY 2017
samumsf.org

2. This presentation
To list the scale of the global epidemic and the response
To list the global targets we are working towards
To list MSF’s response to the HIV epidemic

3. Number Living with HIV
By the end of million people (adults and children) are living with HIV
1.8 million of those infected are children and 52% of all those infected live in eastern and southern Africa
36.7 million living with HIV 1.8 million are children 19.0 million in East and Southern Africa

4. Number of PLWHIV in antiretroviral therapy
By June 2016 it is estimated that 18.2 million people infected with HIV are receiving antiretroviral therapy.
With the new guidance to treat all people living with HIV global coverage has now reached 49%

5. Antiretroviral Coverage by Region 2010-2015
Although the numbers on ART have increased significantly there remains wide variations in ART covergage according to region with the middle east , eastern europe and central asia and west and central africa lagging behind in their response
Wide variation in coverage by region

6. Number of deaths from AIDS
Despite the massive scale up of treatment with antiretroviral therapy there were still 1.1 million deaths attributed to AIDS , 110,000 in children and 43% in eastern and southern africa in 2015
1.1 million AIDS related deaths
110,000 AIDS related paediatric deaths
470,000 AIDS related deaths in east and southern Africa

7. Number of new HIV infections 2015
And 2.1 million new infections in 2015 , 150,000 of which were in children and 46% in eastern and southern africa
2.1 million new infections
150,000 new paediatric infections
960,000 new infections in east and southern Africa

8. The number of new infections decreased in eastern and southern africa
New HIV infections
The number of new infections decreased in eastern and southern africa
Increased in eastern europe and central asia
Remained stable in all other regions
Although the number of infections remains significantly higher in Africa the number of new infections has declined over the last 5 years
This contrasts with eastern europe and central asia where there has been a significant rise in the number of new infections

9. Distribution of new infections by region 2014
Majority of new infections:
Asia and Pacific, Latin America and Middle east and North Africa : majority in a combination of key populations
Eastern Europe and Central Asia : majority PWID
Africa : General Population
Across the different geographical regions different subpopulations account for the majority of new infections
For example in eastern europe and central asia the majority of new infections are occuring in people who inject drugs ( PWID) whilst across Africa the epidemic remains generalised with the majority of new infections occuring in the general population

10. So what are the current global targets ?

11. The UNAIDs Fast-Track Targets
By 2020:
Fewer than 500,000 new infections
Fewer than 500,000 AIDS related deaths
Zero discrimination
By 2030
Fewer than 200,000 new infections
Fewer than 200,000 AIDS related deaths
Zero discrimination
UNAIDS has set the global fast track targets – aiming by 2030 for fewer than 200,000 new infections ( 10x less than we currently achieved ) and fewer than 200,000 AIDS related deaths ( 5 x less than was seen in 2015 )

12. Global Treatment Targets 2000-2030
Global treatment targets have doubled every 5 years since 2000 and with the introduction of treat all will need to double again
Global treatment targets have doubled every 5 years since 2000 and need to double again

13. The 4 “90” Targets
90% of people who know their HIV positive status are accessing treatment
90% of people receiving treatment have suppressed viral loads
90% of people living with HIV know their status
73% of all PLWHIV with suppressed viral loads
90% of all PLWHIV know their status
81% of all PLWHIV on treatment
In addition to these fast track global targets the majority of countries have also adopted the UNAIDS targets which address each step of the HIV continuum of care.
The goal is that 90% of people living with HIV know their status , 90% of people who know their status are accessing treatment and 90% of those on treatment have suppressed viral loads
Overall this equates to 73% of all people living with HIV
A fourth 90 has also been added to address prevention services – stating that 90% of people have access to HIV combination prevention services
90% of people have access to HIV combination prevention and sexual and reproductive health services

14. The global : 2015
The global estimates show that the biggest gap to be addressed is the first target – identifying all those who are living with HIV . To do this innovative strategies will be needed and are discussed in the testing resource section
Source Global AIDS response progress reporting: (WHO/UNAIDS estimates )

15. The WHO guidelines
To support the scale up to these global targets WHO has developed 4 key guidelines , HIV testing services ,the consolidated guidelines for the use of antiretroviral drugs for treating and preventing HIV infection, a guideline specifically for prevention diagnosis and treatment for key populations and guidance for strategic information. They are all available on the WHO website and are included in the relevant resource pages on the SAMU website

16. What about the resources needed for scale up ?
In low and middle income countries:
$19.2 billion estimated resources available for AIDS response 2014
$26.2 billion estimate of what is needed by 2020 to reach the fast track targets
$19.3 billion peak investment needed in 2017 to achieve the targets
7.3 billion needed for HIV prevention by 2020
57% of total investments in AIDS response are from domestic funds
$7 billion gap in resources available in 2014 and what is needed by 2020
A massive increase in funding is required to meet these ambitious targets
$26.2 billion is what is estimated to be needed by 2020 to reach the fast track targets with a 19.3 billion peak investment needed in 2017
Despite an increase in domestic funding to 57% there remains a $7 billion resource gap
Calculated in 2016 based on 2015 programme data

17. Sources of International Funding
Multilateral assistance: The Global Fund to Fight AIDS TB and Malaria, UNITAID and other UN agencies
% of HIV assistance ($1.9 billion) was provided through mutlilateral agencies
The Global Fun is the worlds largets financier of HIV and AIDS
In Sept 2016 the fifth replenishment saw donors commit $12.9 billion between 2017 and 2019
The USA is the largest donor to the Global Fund followed by the UK, France, Germany and Japan
Bilateral Assistance
The majority of donor government funding was distributed directly to recipient countries in 2015 (74%).
‘Bilateral’ funding fell by US$ 715 million on 2014 levels with the USA accounting for the majority of this fall (57%)
One source of bilateral funding is the President's Emergency Plan for AIDS Relief (PEPFAR)
Since 2003, PEPFAR has spent US$ 70 billion on programmes globally to combat HIV and AIDS, tuberculosis, malaria and other opportunistic infections.
Where multilateral and bilateral funding from
USA (66.4%), United Kingdom 13%,France 3.5%,Germany 2.7% , Netherlands 2.3%
Since 2006, these five countries have accounted for roughly 80% of all HIV funding from donor governments
International HIV funding has traditionally come through both multilateral agencies such as the global fund , UNITAID and other UN agencies and trough bilateral assistance. The largest bilateral funding source is PEPFAR the presidents emergency plan for AIDS relief which has spent to date $70 billion globally on the HIV response
Overall the largest contributor to international funding has been the US followed by the UK France Germany and the Netherlands

18. Source of International Funding
Private philanthropic organisations
Provided US$ 618 million for global HIV and AIDS programmes in 2014 –Private philanthropic organisations provided US$ 618 million for global HIV and AIDS programmes in 2014 – an 8% increase on 2013
The Bill & Melinda Gates Foundation is the leading philanthropic funder of international HIV efforts.
To date, the foundation has committed more than $3 billion in HIV grants to organisations around the world and has given an additional $1.6 billion to the Global Fund.
Additional funding has also been made available through philanthropic organisation with the Bill and Melinda Gates foundation leading these efforts

19. Key Messages
Of the 36.7 million people living with HIV globally just under half are accessing treatment
Access to ARV treatment has significantly increased but there are wide variations across the geographical regions
In most regions the number of new infections has remained stable or slightly decreased except for eastern europe and central asia
Ambition global targets have been set aiming for 73% of all those living with HIV to have a suppressed viral load and 200,000 new infections by 2030
Despite a significant increase in domestic funding much of the repsonse continues to rely on the commitment of international donors through multi and bi-lateral funding mechanisms: Will this commitment be enough ?
In summary great achievements have been made over the last decade with just under half of all people living with HIV now accessing treatment
Despite this there remain large differences between coverage across the regions with west and central africa and eastern europe and central asia lagging behind.
In addition eastern europe and central area is the only region to see an ongoing increase in the number of new infections
UNAIDS has set ambitious global targets with the targets aiming overall for 73% of all people living with HIV to have a suppressed viral load
To reach where we are today has relied on a significant global and domestic commitment to fight the epidemic. The question remains will ongoing multi and bilateral funding mechanisms be able to contribute enough to reach the $26.2 billion needed by 2020.