1. UNAIDS, Regional Support Team, Eastern and Southern Africa
New targets post 2015: Leave No One Behind
Jacqueline Makokha
UNAIDS, Regional Support Team, Eastern and Southern Africa
20 August 2014

2. HIV epidemic in the ESA region (2013)
Number of people living with HIV million
Number of children living with HIV million
Number of new HIV infections million
Number of new HIV infections
among children ,000
Number of AIDS deaths ,000
Number of people receiving ART million
The region explains about 50% of the global burden of HIV, with about 18.5 million people currently estimated to be living with HIV. A lot of variation in the epidemics in the region and the rates at which incidence is falling. The pace at which we scale up the response in ESA will determine how quickly we can move towards an AIDS-free generation.
Source: UNAIDS 2014

3. Overview of the HIV epidemic in the ESA region (2013)
However, significant progress has been made by countries in the ESA region. The dramatic scale-up of ART (7.7 million people were receiving ART in the region in 2013) has resulted in a significant decline in AIDS-related deaths and has contributed to the reduction in HIV transmission. New infections in the region has fallen by 32% and AIDS related deaths by 46% between 2005 and 2013.
Source: UNAIDS 2014

4. Overview of the HIV epidemic in the ESA region (2013)
PMTCT coverage has reached 78% in 2013 in the ESA region. AS a result of the scale-up of PMTCT services to pregnant women, new infections among children has fallen significantly and the region is on track to reach the 2015 elimination target.
Source: UNAIDS 2014

5. The importance of location and population
If we want to control the HIV epidemic we need to focus on location and population group. In this region, it is important to particularly focus on young women, pregnant women, sex workers. However, men who have sex with men, migrant workers, people who are displaced, and people who are older than 50 years contribute substantially to the HIV burden and their needs should also be addressed.

6. HIV prevalence among young women and men aged 15-24 years in East and Southern Africa in 2013
This slide shows the substantial differences in HIV prevalence between young women and men aged years and highlights the vulnerability of young women.
Source: UNAIDS 2014

7. HIV prevalence among South African boys and girls in grades 9 and 10 in a rural district
Extrsaordinary increase in prevalence among young women in grades 9 and 10 in a rural district in South Africa. By age 20, more than 15% of young women are infected with HIV, compared to less than 2% prevalence among young men of the same age.
Source: Kharsany, A. B., M. Mlotshwa, et al. (2012). BMC Public Health 12: 231.

8. Challenges: Key populations (PHID, MSM, FSW) a substantial share of new infections
Swaziland ≈ 12%
Mozambique ≈ 20%
South Africa ≈ 25%
Kenya (incl. prison pop) ≈ 30%
Studies that have been conducted in several countries in this region indicate that populations at high risk of infection, including men who have sex with men, female sex workers, people who inject drugs and prison populations contribute to substantial numbers of new HIV infections and highlights the importance of targeted interventions for these populations.
Source: Gouws E, Cuchi P. Sex Transm Infect 2012;88:i76–i85

9. HIV prevalence among MSM in Africa
Ranging from:
6% in Cairo to
31% in Cape Town
This slide shows the high prevalence among MSM in Africa, ranging from 6% in Cairo to 31% in Cape Town. In most countries, prevalence among MSM is substantially higher than among men in the general population.
Source: Griensven et al. Current Opinion in HIV and AIDS 2009

10. Global HIV prevalence among adult female sex workers, 2013
This map shows the global burden of HIV among adult women sex workers up through There are data from 79 countries and over 430,000 women.
Source: Beyrer, et al, The Lancet, 2014.

11. Percentage of adults (aged 15+) and children (aged 0-14) living with HIV who were receiving ART in 2013, in 21 priority countries
Coverage of ART has increased dramatically over recent years and good coverage among adults were observed in However, ART coverage among children is lagging behind in most countries, with the exception of Botswana.
Source: UNAIDS 2014

12. HIV treatment cascade for adults in sub-Saharan Africa aged 15 years or more, 2013
While ART coverage has increased dramatically, it is estimated that only 45% of people living with HIV in SSA know their status, 39% are receiving treatment, and 29% have viral load suppression. Clearly, a lot more needs to be done to get people tested, to put them on treatment, and to make sure that they adhere to treatment. There also need to be exceptional efforst to ensure that no-one is left behind and that marginalized populations are also reached.

13. Source: UNAIDS / UNICEF / WHO

14. Summary of the epidemic in ESA
Remarkable progress has been made in the region
Significant increase in ART and PMTCT coverage
Significant decline in AIDS deaths and in TB/HIV deaths
Important declines in new adult and child HIV infections
Funding support for the HIV response has been extraordinary and has enabled countries to significantly expand their responses
Increased focus on improving effectiveness and efficiency of the response

15. Population groups left behind

16. 12 population groups left behind
Adolescent girls
Prison populations
Immigrants
People who inject drugs
Older people who are HIV+
Older people who do not think they are at risk
Sex workers
Transgender women
Children left behind on treatment
Women of reproductive age
HIV+ displaced persons
People with disabilities
Globally, adolescent girls and young women face gender-based inequalities, exclusion, discrimination and violence, which put them at increased risk of acquiring HIV.
Adolescent girls and young women are most vulnerable to HIV in sub-Saharan Africa—and account for 1 in 4 new HIV infections.
The prevalence of HIV, sexually transmitted infections, hepatitis B and C and tuberculosis in prison populations has been estimated to be between two and 10 times higher than in the general population.
Globally, there are 230 million international migrants. With heightened vulnerabilities, migrants rarely have access to HIV-related health and social services.
Approximately 13% of people who inject drugs are living with HIV. HIV prevalence is estimated to be 28 times higher in people who inject drugs than in the rest of the adult population.

17. Source: Human Sciences Research Council / Centers for Disease Control and Prevention / Human Rights Watch / Ukrainian Institute for Social Research after Olexander Yaremenko and United Nations Office on Drugs and Crime

18. Source: UNAIDS / UNODC

21. New targets post 2015

22. Why new targets are needed
New targets are needed for four reasons:
1) Targets drive progress
2) New scientific evidence has emerged 
3) New targets are needed to guide action
4) Bold new targets to end the epidemic
demonstrates that AIDS is a winnable fight

23. HIV Treatment access gap
And if we apply the new guidelines, the gap widens

26. To end the AIDS epidemic as a public health threat by 2030 the UNAIDS called on the world to adopt a new target ’ ’
90% reduction in new infection, 90% reduction in stigma and discrimination and 90% reduction in AIDS-related deaths
In order to achieve these targets, firstly, need to build a strong momentum TO END AIDS by 2030 and secondly, ensuring an AIDS response that leave no one behind.

27. Ending AIDS, leaving no one behind
Too many people are left behind today – a challenge
12 populations left behind by AIDS response (Sex workers, men who have sex with men; bisexual, transgender and intersex people; prisoners; people who inject drugs; migrant workers, people with disabilities; and women and girls)
Need to address stigma and discrimination
Close the gap between people who are reached with HIV services and people who are not
Require research and innovation combined with protective laws
Ending AIDS by 2030 is not possible, without a people-centred approach and we will not go far in the post-2015 era.
As we saw in the new UNAIDS Gap report, 2014, our challenge boils down to one painful truth: too many are being left behind today.
In the gap report, we saw that 12 populations left behind ( List them)
We will not end this epidemic if we continue to stigmatize and neglecting the needs of the populations left behind.
Not all have equitable access to HIV prevention, treatment and care and support services. Some populations do not have access because they are marginalized, others because of
harmful gender norms, poverty, legal and social inequalities. Where HIV services are available, uptake is dependent on the quality of services as well
as the levels of stigma and discrimination by service providers.
Need to close the gap between people who are reached with HIV services and people who are not reached through services and this will require countries to have very good understanding of the mico-epidemics.
This will require research and innovation combined with protective laws that promote freedom and equality for all people.

28. Thank you