HIV and AIDS Response: Progress under Threat Dr. Mit Philips International Seminar BTC-CTB, 30 November 2012

What’s new? A deadly epidemic still raging at the heart of communities Starting to see mitigating effect of a decade of global mobilisation Hope but fear for complacency and HIV fatigue

People accessing treatment People Waiting to access treatment

Good news Better and simpler drugs - cost-effective Patients on ARV can live healthy lives ARV Treatment leading to viral suppression > stop transmission Bend the epidemic curve is possible  Pay now : more efficient

Good news We can simplify and decentralise care closer to patients > better access & adherence Countries want to start earlier with less toxic drugs > lives saved and less burden on health system Perspective of innovations for improved care: viral load, better and longer working drugs...

But... Not all people get access

But... Global figure hides very different situations

Democratic Republic Congo Consequences for patients, their family, health workers & health system

Progress missing Lack of resources = main crunch, not lack of operational capacity Financing source of ARV GF 11% UNITAID 2% Others 1% Waiting 86%

Neglected crisis = crisis caused by neglect MSF and civil society approached pro-actively all health donors without success  No mobilisation for a bridge fund  US/PEPFAR: only prevention (PMTCT max 18 months)  Health care programmes of EC & other health donors do not include treatment  EU member states: “This is the role of the GF”

The importance of speed up & scale up

Remember: How did we get this far?

HIV/AIDS: The need for an exceptional approach

Remember: How did we get this far? WB/MAPPepfarGlobal Fund Domestic resources

Loosing momentum? Overall international funding for HIV stagnating Ending specific treatment access efforts Funding shift away from recurrent costs and in particular ARV purchase Global Fund only channel for ARV? Vulnerable! Health MDGs no longer priority post 2015 Be patient, a few more strokes and I’ll soon have the momentum going

Time for a different approach? WB PepfarGlobal Fund Domestic resources to the rescue ! Capacity Building and sustainable systems? Cancelled To do more To replace donor retreat? From emergency to sustanability

Return of the financial sustainability paradigm? Financial Sustainability paradigm But wait a moment.... Wasn’t this the problem we had to overcome when we started this global fight?

Zimbabwe Funding gap due to end international funding for ARV purchase by Health Transition Fund (funded also by EC and EU MS) Domestic funding:  Already ARV of 25% of people on tt paid by HIV levy Seeking $$$ > ‘why not make patients pay for treatment?’ Risk = Compromise quality and access of HIV response; slow down initiation

DRCongo Who finances the fight against HIV in DRC? Govt. Households Donors. Households paying most Civil society pressuring its government > when result? Meanwhile what options...?

World AIDS Day Next year: ??? To fit sustainability conditions Towards Universal Health Coverage?

Today halfway between hope and despair

The fight goes on... Every day No time for complacency For patients on treatment For people waiting for treatment For health care workers For communities affected by HIV

The fight goes on... Every day Challenges enough to fight for on the field: People waiting for initiation People fear stock outs of ARV and OI drugs People need further simplified treatment People want to know their status People fight stigma and neglect People want their nurses and lay counsellors at work People need lower drug prices and fight patents

The fight goes on: where are you?

Make it/ Keep it a common fight- a global fight