Dr. Socorro Gross-Galiano Assistant Director Ministerial Meeting on HIV and Development in Latin America and the Caribbean ECOSOC - Annual Ministerial Review Jamaica, 4-6 June 2009 Sustained Response to HIV: Financial Challenges

Source: UNAIDS, 2008 ( last available year ) HIV financing in selected countries We should sustain our support to countries with funding gaps and avoid setbacks on what we have already achieved Where does the financing for the r esponse come from? Domestic International

Prevention (Young People / Risk Groups, Vertical Transmission) Early Detection Interventions that address the social and epidemiological reality PHC based Health Systems with positive synergies Mechanisms to improve interventions, efficiency and reduce costs Strengthen inter-sector collaboration Sustained Response to HIV: Financial Challenges What is the roadmap ? Eliminate stigma and discrimination

Protecting achievements (ART, blood safety) Making progress in areas lacking adequate attention (high-risk populations needs, stigma and discrimination, PMTCT, sexual transmission prevention, epidemiological surveillance, ) Health sector Provides important role of the response – leads inter-sectoral work, key for a sustained & comprehensive response. Components of a Sustained HIV Response

Innovations in therapeutic approaches (early adoption) New infections will require treatment Sizable number of infected people are still without access to treatment People receiving ART will continue needing them ( more expensive plans) Response should be maintained and expanded IT IS URGENT! Prioritize prevention reducing rate of new infections, targeting high-risk populations, work on stigma and discrimination and using resources rationally.

For what? Estimates correspond to: Human Resources Materials Equipment Infrastructure the challenge is not limited to financial resources! Necessary to introduce mechanisms that reduce c osts of providing services at all levels of the system and b arriers to access - including out-of-pocket expenditures, stigma and discrimination Needed for the delivery of interventions that allow meeting of targets …

The financial crisis… Finds us with some of our health systems fragmented This has an impact on - The rational use of resources The response capacity by the health sector … including HIV!

HIV HIV is controlled, benefits are achieved, LIVES ARE SAVED Reforms in the Re-orientation of PHC - based Health Systems Strong health systems = Robust response Universal Coverage Organization of Services Leadership Reform Public Policies

Due to insufficient coverage, an estimated 12,300 children were born in 2007 with the virus or were infected during lactation. Impact on children:  Lack of opportunity from birth;  Vulnerability Social responsibility and of health systems  Deliver Social Protection  Cover treatment costs Progress on ARV Access to prevent mother to child transmission in LAC % of HIV+ pregnant women that receive ARV for PMTCT

$25,483 to $140,222 (US) ARV range Cost total in the Region: $313 million & $ 1.7 billions (US) Costs of not preventing Maternal-Child Transmission Cost of ART per child from 2 months to 15 years of age (US $) Prices Strategic Fund Prices negotiated without the application of international reference pricing The cost of treatment with ARV for 15 years per infected child varies Cost of preventing a case of mother to child transmission is estimated at US$500 Cost can be minimized if prevention is provided by an integrated maternal care network.

Options to reduce and contain drug and resource costs Purchase of ARV - Two scenarios - Innovators (Chile) versus Generics (Peru ), under the same centralized purchasing system US Dollars (US$)

Low access by most vulnerable populations Lack of regulation to improve access to drugs Insufficient strategies to ensure access to drugs within the PHC framework Limited dialogue among interested parties to promote universal access Difficulties in pharmaceutical markets

Critical points in the intersectoral collaboration EDUCATION Monitoring the Inter-ministerial Declaration of Mexico at the national level LABOUR Links with the labor sector CIVIL SOCIETY Coordination with civil society organizations JUSTICE Protection of Human Rights FINANCE & TRADE Protect public health & ensure equitable access to drugs & other products SOCIAL SECURITY Include children orphaned by HIV PRIVATE SECTOR Prevention, protection and inclusion of people affected by HIV Coordination and inter-sectoral collaboration Now more than ever! We need to invest in collaboration & coordination

To cooperation and financing partners: Promote utilization of strategies and coordination mechanisms Harmonize collaboration mechanisms and lessen demands on countries Collaborate with countries to improve cost & efficiency of preventive efforts Promote interventions and investments to strengthen local systems and capacity. Recommendations

To social policy makers : Include people affected by HIV, in social protection programs including children orphaned Allocate public spending to sustain achievements and bridge gaps Prioritize vulnerable & high risk populations in addressing health determinants Recommendations

To national actors Revisit PHC and coordinate an integrated health system response Re-prioritize preventive interventions targeting high-risk and vulnerable groups Mainstream sex education Establish an early warning system to minimize treatment interruption and reduce new infections. Recommendations

To national health authorities: Revitalize leadership role in policy-making, coordination, and management of resources allocated to HIV Revise model of care for HIV including organization & delivery; Conduct critical analysis and data analysis to identify deficiencies, gaps, and opportunities for intervention in the short-term Define needs for long-term reforms based on analysis results Recommendations

To health services management Coordinate complementary interventions, such as the promotion of sexual and reproductive health with the prevention/care of sexually transmitted infections Incorporate actions within comprehensive and integrated care framework Protect and develop Human Resources for Health to maintain its quality, competency and availability Recommendations

To Media Emphasis on prevention stigma and discrimination Promote voluntary testing and counseling Recommendations

AT ALL LEVELS! PROMOTE solidarity respect the elimination of stigma and discrimination and

Thank You! ¡Gracias! Merci! Muito Obrigado!