Overview of the HIV Epidemic in Eastern and Southern Africa:

1. Overview of the HIV Epidemic in Eastern and Southern Africa:  Are we on track to achieve the HLM 2015 targets? Implications for CSO mobilisation & Capacity Building" Dr. Mbulawa Mugabe, Deputy Director, UNAIDS Regional Support Team for Eastern and Southern Africa

2. 34 million people living with HIV, 2011

3. 2015 targets in the UN Political Declaration 2011 3 5 4 1 2 Eliminate new HIV infections among children and halve AIDS-related maternal deaths Halve sexual transmission 15 million people on HIV treatment Halve infections among injecting drug users Halve tuberculosis deaths among people living with HIV 7 10 9 8 6 Close the global resource gap and achieve annual investment of US$ 22-24 bn Eliminate gender inequalities and sexual violence and increase capacities of women and girls Eliminate parallel systems, for stronger integration Eliminate stigma and discrimination Eliminate travel related restrictions

4. In 2011, there were approximately 2.2 million new infections in adults globally; 1 million of them were in ESA. Decline in New Infections from 2001 to 2011: 7 countries in ESA achieved over 50% 4 countries achieved 26-49% 2 countries achieved 10-25% 3 countries remained stable 1 country showed an increase All countries need to achieve 50% decline from 2009 to 2015 Reduce sexual transmission of HIV by 50%

5. % Change in Incidence 2001 – 2009 Source: UNAIDS Estimate 2012

6. Assist countries identify who is getting infected / who is at risk of infection (KYE/R) Prioritize relevant, effective, and impactful prevention strategies for different populations (IF) Advocate for the scale up of Basic High Impact Program Activities: Increase # of people on ARVs (effect on transmission) Scale up male circumcision as a priority Behavior change programmes Programmes for key populations (almost no data for MSM, sex work, IDU in region) Condom promotion & distribution (Condom use at last sex in Lesotho – 34%) Make smart investments that combine programs with critical enablers to exploit synergies Priority Actions: Sexual Transmission

7. Estimate of Number of Adults 15-49 yrs. VMMC needed to reach 80% coverage / country (PEPFAR Data)

8. Estimate Number of VMMC done / country as of October 2011 (PEPFAR Data)

9. Estimate Number of VMMCs needed to prevent one HIV infection (PEPFAR Data)

10. Practically no data for IDU (and other key populations) in the region Country Action: Prioritize collection of data on IDU in the region Reduce HIV transmission among people who inject drugs by 50% Source: compiled from academic sources that are not comparable

11. Global – approximately 330,000 babies were born with HIV in 2011; 55% or 180 000 were in ESA Nearly 90% of all new HIV infections among children globally occur in 22 countries – 21 of those countries are in Africa, and 14 are in ESA Global Plan aims to reduce new infections in infants by 90% from 2010 levels, by 2015; requires achieving >90-95% coverage for high quality PMTCT services in priority countries Eliminate new infections among children and reduce AIDS-related maternal deaths

12. Percentage Coverage of PMTCT Services 2011 (excluding SD Nevirapine) Countries 2 - 49% Countries 50 - 79% Countries >80% • ESA coverage for PMTCT services in 2011 was 72% • PMTCT coverage in five is low

13. Priority Country Actions: Implement the Global Plan on EMTCT • Frame it – Develop an EMTCT Plan • Advocate for it – Leadership, communication • Do it – Implementation (4 prongs) • Account for it – M&E, shared responsibility • Almost all countries have developed emtct plans – follow up on implementation; • CARMMA is bring launched across countries in the region – follow up on implementation

14. # of persons living with HIV in ESA 2011 – 17.1m # of persons eligible for ART using CD4 350 guidelines – 8.1m # of persons on ART 2011 – 5.2m (64% coverage) Unmet need for ART – 2.9m Epidemiological projections shows that if the 15x15 target is met by 2015, 80% of those in need of ART will be receiving therapy Reach 15 million PLHIV with ART by 2015 Source: UNAIDS & WHO Estimates, 2010

15. Estimated ART Coverage (CD4<350) 2011 Countries <50% Countries 50 - 79% Countries >80% Source: WHO Data 2012 • 5 countries Rwanda, Botswana, Namibia, Swaziland and Zambia have achieved > 80% coverage; consider treatment for prevention

16. Increase ART Demand: Promote testing campaigns for early diagnosis and commencement of therapy Push for Treatment for Prevention especially in countries that have achieved high ART coverage (e.g. Botswana) Improve Supply: simplify the way HIV treatment is currently provided (e.g. fixed dose combination ARVs for children in Uganda; CD4 testing devices at select clinics in Mozambique reduced test time from 27 days to 1 day) decentralize provision of services (e.g. shift from hospitals to health centers and from clinical officers to nurses in Malawi) Better Intelligence: forecasting on medicines and commodities to prevent stock outs Priority Country Actions: 15x15

17. TB is a leading killer of people living with HIV causing one quarter of all deaths. People living with HIV and infected with TB are 20 - 30 times more likely to develop active TB disease, compared to people without HIV. In 2010 there were an estimated 1.1 million new cases of HIV-positive new TB cases globally; approximately 60% occurred in ESA In 2010, about 350 000 people died of HIV-associated TB globally. Almost 250 000 deaths were in ESA Reduce TB deaths in PLHIV by 50% Source: WHO Report 2011: Global Tuberculosis Control Data for ESA extrapolated

18. HIV Prevalence (Percent Estimate) in New TB Cases, 2009 < 25% 25 – 50% 50 – 83% Source: WHO 2010 In South Africa, Lesotho, Swaziland, Namibia, Botswana, Zimbabwe, Zambia, Mozambique, Malawi & Uganda, more than 50% of new TB patients are HIV positive

19. Ensure that TB burden reduction in people living with HIV is sufficiently addressed in NSPs Mobilize partners to provide the technical support to countries assisting them to scale-up HIV and TB responses (WHO is lead agency) Advocate for HIV programmes in countries to effectively implement TB prevention, treatment, care and support (service integration) Social movement building and activism for PLHIV & TB. Priority Actions in TB/HIV Epidemics

20. Global Investment of US$22-24b / year in low and middle income countries • By 2010, Africa had mobilised close to US $ 8bn from both International and Domestic Sources • The increase in domestic resources is smaller than that of international resources • Advocate for implementation of the African Union Roadmap

21. Share of care and treatment expenditure originating from international assistance, African countries, 2009–2011 Source: Global AIDS Response Progress Reporting country reports (most recent available). • Most countries in SSA are more than 50% dependent on international sources for treatment;

22. HLM Target 7:Eliminate Gender Inequalities & GBV and Increase Women and Girls’ Capacity to Protect Themselves from HIV

23. HLM Target 7:Eliminate Gender inequalities & GBV and increase women and girls’ capacity to protect themselves from HIV

24. HL HLM Target 8: Eliminate stigma & discrimination against PLHIV thru laws & policies that protect human rights fundamental freedoms

25. HLM Target 8: Eliminate stigma & discrimination against PLHIVthru laws & policies that protect human rights fundamental freedoms

26. HLM T Target 9: Eliminate HIV-Related Restriction on Entry, Stay and Residence • Only Two Countries in the ESA Region Criminalise stay and entry for PLHIV. • Intensify advocacy for a “final push” for the removal of these restrictions Source: Making the Law work for the HIV Response, July 2010

27. Strengthen integration of the AIDS response in global health and development efforts • Integration means different things to different people; need to use a standardized definition such as the health systems framework based on the 6 WHO building blocks • No indicators yet on how to measure the integration of HIV into the general health and development sphere in a country. No indicators developed for 2012 country reporting. • UNAIDS part of the EU/UNFPA/UNAIDS Collaboration supporting the integration of HIV and SRHR in seven Southern African countries. • UNAIDS Participating in Experts Meeting to develop indicators for Integration of HIV and SRHR at policy and service delivery levels; may shed light on monitoring of this HLM target.

28. Sexual Prevention: Evidence & Prioritisation: Gather more evidence on where infections are coming from and prioritise high impact interventions; • IDU: Evidence generation, political support & Implementation of harm reduction programmes; • EMTCT: Familiarise yourselves with your country emtct plans, provide community based monitoring of implementation; • Treatment: Promote testing (especially of men), advocate for simpler innovations in testing and treatment, treatment is prevention and treatment outcomes not just coverage; • HIV/TB: Service Integration • Money: 15% campaign, domestic funding , local manufacture (AU road map • Gender: Scale up men’s engagement & work with community structures to end GBV • Stigma & Discrimination: Country Stigma index reports, evidence on key populations and HIV, political support and concerted action of advocacy to remove punitive laws • Travel, stay and residence: advocacy for removal in 2 countries, monitor others; • Integration: advocacy for service integration and contribution to indicator exercise

29. VISION ZERO NEW HIV INFECTIONS. ZERO DISCRIMINATION.ZERO AIDS-RELATED DEATHS.