Taking the Pulse: Global Update on the Health Sector Response to HIV, 2014 Dr Gundo Weiler Coordinator Strategic Information HIV Department World Health Organization WHO Satellite at AIDS2014, 20 July 2014

Global Health Sector Strategy on HIV/AIDS a new health sector agenda for HIV/AIDS Leverage broader health outcomes through HIV/AIDS responses Reduce vulnerabilities and remove structural access barriers Build strong and sustainable health systems Optimize HIV prevention, diagnosis, treatment and care ❷ ❸ ❶ ❹

Gauging recent progress in the global HIV response 2.1 million HIV infections ▼ 15% HIV infections in children ▼ 40% 1.5 million HIV related deaths ▼ 25% TB-related deaths in PLWHA * ▼ 36% ** *2012** [1.9 – 2.5 million] [1.4 – 1.7 million] [ – ] [ – ]

Outline 01 | Prevention, diagnosis, treatment and care ART PMTCT Prevention 02 | Service integration 03 | Systems strengthening 04 | Removing structural barriers

Methodology Global AIDS Response Progress Reporting (GARPR) Annual reporting of programme data by countries (MoH, NAPs), electronic platform managed by UNAIDS, validated jointly by WHO, UNICEF, UNAIDS By June 2014, 131 out of 144 low- and middle income countries provided ART data, representing 99% of estimated total number of people on ART at end of 2013 Country policies and practices Real-time tracking of implementation of HIV health sector policies in practices in 58 focus countries, including UBRAF high impact countries and Global Plan countries Country submission through GARPR and validation/completion by WHO in-country staff.

12,9 million people on ART at the end of 2013 globally. 11,7 in low-and middle income countries - 2 million more than at the end of 2012 Actual and projected numbers of people receiving antiretroviral therapy in low-and middle-income countries, and by WHO Region, 2003–2015 Source: 2014 Global AIDS Response Progress Reporting (WHO/UNICEF/UNAIDS). Catalyse HIV treatment, care and support

Africa, with most people living with HIV, continues to drive global scale-up, but low-coverage Regions are catching up Catalyse HIV treatment, care and support Total: 11.7 million in LMIC 36% % % % % % % Source: 2014 Global AIDS Response Progress Monitoring (WHO/UNICEF/UNAIDS) and UNAIDS/WHO/UNICEF estimates

Global scale-up driven by large increases in ART for adults Adults 9,0 m 10,9 m + 21% > 1 in 3 adults with HIV on ART (37%) Catalyse HIV treatment, care and support Source: 2014 Global AIDS Response Progress Monitoring (WHO/UNICEF/UNAIDS) and UNAIDS/WHO/UNICEF estimates

The gap between access to ART for children and adults continues to widen Adults Children 9,0 m 740 k 10,9 m 640 k + 21% + 15% 1 in 4 children with HIV on ART (23%) Catalyse HIV treatment, care and support > 1 in 3 adults with HIV on ART (37%) Source: 2014 Global AIDS Response Progress Monitoring (WHO/UNICEF/UNAIDS) and UNAIDS/WHO/UNICEF estimates

HIV has become the 2 nd biggest cause of death for adolescents globally Catalyse HIV treatment, care and support Source: Health of the world’s adolescent, WHO 2014

Access to ART for people who inject drugs remains insufficient, the example of Eastern Europe PWID among all PLWHA PWID among all on ART People who inject drugs as a proportion of all people living with HIV with a known transmission route and The proportion of people who inject drugs Who received antiretroviral therapy in reporting countries, WHO European Region Catalyse HIV treatment, care and support

Outline 01 | Prevention, diagnosis, treatment and care ART PMTCT Prevention 02 | Service integration 03 | Systems strengthening 04 | Removing structural barriers 05 | Looking ahead

Close to 1 million pregnant women received ARVs, 500,000 still being missed Eliminate new HIV infections in children Source: 2014 Global AIDS Response Progress Monitoring (WHO/UNICEF/UNAIDS) and UNAIDS/WHO/UNICEF estimates

Source: Global AIDS Response Progress Reporting (WHO/UNICEF/UNAIDS) and 2013 UNAIDS estimates. Reaching the global target will depend on progress in some high burden countries with persisting low coverage Eliminate new HIV infections in children Tanzania DR of the Congo

Eliminate new HIV infections in children Steady increase in roll-out of Early Infant Diagnosis, but still too few exposed children tested Pooled coverage of EID in 88 countries with data from 2011 and 2013 Source: 2014 Global AIDS Response Progress Monitoring (WHO/UNICEF/UNAIDS)

Outline 01 | Prevention, diagnosis, treatment and care ART PMTCT Prevention 02 | Service integration 03 | Systems strengthening 04 | Removing structural barriers 05 | Looking ahead

Key populations are disproportionally affected by HIV, and disturbing news on outbreaks across all regions Average HIV prevalence in key population surveys and general population Invigorate HIV Prevention Source: Unpublished literature review based on 88 country studies, Sex worker Men who have sex with men Transgender people People who inject drugs

But still glaring gaps in addressing the needs of key populations in national HIV plans Percentage of 58 WHO HIV Focal Countries with explicit reference to specific key populations in their national HIV/AIDS Plan, June 2014 Invigorate HIV Prevention

VMMC increased by 50% in 2013 to a total of 5.8 million, but its full potential is far from being exhausted

Outline 01 | Prevention, diagnosis, treatment and care ART PMTCT Prevention 02 | Service integration 03 | Systems strengthening 04 | Removing structural barriers 05 | Looking ahead

Accelerating increase in ART coverage among notified TB patients to 70% Percentage of people coinfected with HIV and notified TB who initiated ART, 2007–2013 Service Integration Source: provisional data from the Global Tuberculosis Programme Database, June 2014

85% of all ANC attendees were tested for syphilis - countries are targeting dual elimination Service Integration Percentage of antenatal care attendees tested for syphilis at first visit, 2012 Source: 2014 Global AIDS Response Progress Monitoring (WHO/UNICEF/UNAIDS)

HIV is supporting an emerging hepatitis agenda Service Integration Share among 58 WHO HIV focus countries offering hepatitis services in ART clinics, June 2014 Source: WHO HIV Country Intelligence Database, June 2014

Outline 01 | Prevention, diagnosis, treatment and care ART PMTCT Prevention 02 | Service integration 03 | Systems strengthening 04 | Removing structural barriers 05 | Looking ahead

Prices continue to decrease, but stockouts remain of concern Median prices of WHO-preferred first-line regimens per person per year, in US dollars, in low-and middle-income countries, 2004–2013 Systems Integration

In multiple countries laws, regulations or policies exist that can hinder service provision for key populations Human Rights and Access Barriers MSM Sex workers PWID Source: GARPR 2013 – “Countries reporting existence of laws, regulations or policies that can pose obstacles to effective HIV prevention, treatment, care and support services for key populations”

Outline 01 | Prevention, diagnosis, treatment and care ART PMTCT Prevention 02 | Service integration 03 | Systems strengthening 04 | Removing structural barriers 05 | Looking ahead

Rapid uptake of 2013 ARV guidelines increases eligibility Percentage of 58 WHO HIV Focal Countries with confirmed adoption of select WHO 2013 ARV recommendations, June 2014 _ * or 75% of 22 EMTCT Global Plan countries * Source: WHO HIV Country Intelligence Database, June 2014

Ending the AIDS epidemic by 2030 Source: UNAIDS estimates (2014), Gap report

Child – adult coverage gap is widening Rapid uptake of new guidance, innovation is driving country responses New eligibility criteria call for new ambitious treatment targets Conclusions: Main figures and messages 12.9 million on ART globally, record 2 million increase in million on ART globally, record 2 million increase in children on ART, only 15% more than in children on ART, only 15% more than in % of countries have adopted 2013 ARV guidelines HIV response blazes the trail for universal health coverage Consolidation around integrated [HIV] service packages Failure in reaching key populations Since 2009, 25% drop in mortality, but only 15% drop in incidence

Acknowledgements Countries: Ministries of Health and National AIDS Programmes from 181 countries WHO: Andrew Ball, Txema Calleja, Michel Beusenberg, Chika Hayashi, Theresa Babovic (cons.), Hein Marais (cons.), Isabel Bergeri, Gottfried Hirnschall, Meg Doherty, Rachel Baggaley, Jos Perriens, Marco Vitoria, Nathan Shaffer, Vincent Habiyambere, Boniface Dongmo, Eyerusalem Negussie, Martina Penazzato, Tunga Namjilsuren, Haileyesus Getahun, Annabel Baddeley, Emil Asamoah Odei, Frank Lule, Ying-Ru Lo, Dongbao Yu, Amaya Maw, Massimo Ghidinelli, Monica Alonso, Gabriele Riedner, Hamida Khattabi, Martin Donoghoe, Irina Eramova, Annemarie Stengaard UN organizations: Peter Ghys, Mary Mahy (UNAIDS); Craig McClure, Chewe Luo, Priscilla Idele, Rosalind Carter (UNICEF) Partners: Lara Stabinski (OGAC); Laura Porter, John Aberle-Grass (CDC); Chris Duncombe (BMGF); Alvaro Bermejo, Gitau Mburu (AIDS Alliance); Asia Russell (HealthGAP); Tony Harries (Union); Ade Fakoya (GFATM); Mark Harrington (TAG); Vincent Wong (USAID); Tim Hallet (Imperial College); Tsehaynesh Messele (ASLM)