1. HIV/AIDS in Latin America and the Caribbean: Challenges Ernest Massiah, Inter American Development Bank Inter American Development Bank

2. Outline 1. Who gets AIDS in LAC? 2. How can the Global Fund resources affect programs 3. Program and policy implications: What works? What works?

3. Key Messages (1) Who gets AIDS prevention and treatment care? Poverty, gender, race/ethnicity matter Who gets AIDS prevention and treatment care? Poverty, gender, race/ethnicity matter High-risk groups have been relatively neglected High-risk groups have been relatively neglected Progress is inadequate on most fronts, especially treatment yet there are large financial resources available. Progress is inadequate on most fronts, especially treatment yet there are large financial resources available.

4. Key Messages (2) Substantial impact on the epidemic can be achieved even with limited resources Substantial impact on the epidemic can be achieved even with limited resources Strong need for more technical assistance at country level Strong need for more technical assistance at country level

5. HIV Prevalence in LAC Adults 2003 HIV Prevalence in LAC Adults 2003 Source:UNAIDS Estimated Prevalence (1 %)

6. HIV Prevalence in selected groups 1998-2002

7. Sex, Love, Monogamy and Risk Data from the 2002 Dominican Republic DHS WomenMen % persons in union with only 1 sexual partner 98.581 % 15-19 yrs in union with > 1 sexual partner 229 Condom use with spouse/ live in partner (%) 2.01.1 Condom use with non resident partner 25.250 Tested for HIV (%) 2953

8. Race and Location, Guatemala 1995

9. AIDS-Poverty Nexus Clear evidence that AIDS deepens poverty Clear evidence that AIDS deepens poverty Less clear evidence on poverty as a cause of AIDS Less clear evidence on poverty as a cause of AIDS AIDS not simply a disease of the poor AIDS not simply a disease of the poor But some dimensions of being poor can increase risk and vulnerability But some dimensions of being poor can increase risk and vulnerability

10. PEI Scores for selected LAC countries - 2000 Source: UNAIDS 2003

11. Percentage of those in Need Receiving ARV Treatment - 2002

12. What Works? ARV distribution can be cost- saving, Brazil, 1997 - 2001 *(UNAIDS)

13. Global Fund Allocations – 2004 ($M)

14. Prevention, Care and Treatment Resource Needs Estimates 2004 - 2007 Source: IDB: 2004 Actual Expenditure 2000 Patterns from National AIDS Accounts in 15 Countries Source: SIDALAC 2003

15. Allocations patterns: Accidents or Intentions? Source: SIDALAC 2001

16. Policy and Program Implications Poverty and gender-oriented approaches Poverty and gender-oriented approaches Target the excluded and hard to reach e.g. condom promotion for poor, less educated; services for high risk groups (MSM), mobile populations Target the excluded and hard to reach e.g. condom promotion for poor, less educated; services for high risk groups (MSM), mobile populations

17. Policy and Program Implications Services that target the poor and at- risk are the most cost-effective: Services that target the poor and at- risk are the most cost-effective: f ree condom distribution targeted to high-risk groups, f ree condom distribution targeted to high-risk groups,  condom social marketing,  IEC for high-risk groups including MSM, commercial sex workers and prisoners, and VCT. Partnerships – NGOs, civil society, private sector: better reach into certain populations Partnerships – NGOs, civil society, private sector: better reach into certain populations

18. Policy and Program Implications Support for governments in developing regulatory and monitoring frameworks. Support for governments in developing regulatory and monitoring frameworks. Prevention and treatment balanced Prevention and treatment balanced

19. Business options?  Read Global Fund proposals  Work with the Country Coordinating Mechanisms (CCM) established by the GF  Focus not only on ARVs but the support systems required – lab testing, CD4, staff training, reagents etc  EVALUATION