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Major Challenges to HIV/AIDS Prevention and Treatment Universal Access and Sustaintability. Pedro Chequer UNAIDS Regional Advisor, Latin America Regional Support Team. . Challenges to HIV Prevention Challenges to ART Sustainability Common Challenges

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slide1

Major Challenges to HIV/AIDS Prevention and Treatment

Universal Access and Sustaintability

Pedro Chequer

UNAIDS Regional Advisor, Latin America Regional Support Team

major challenges to hiv aids prevention and treatment
.Challenges to HIV Prevention

Challenges to ART Sustainability

Common Challenges

Some strategies to cope with these challenges

Major Challenges to HIV/AIDS Prevention and Treatment
slide3

Challenges to HIV Prevention

1) Limited information about the market of prevention supplies, including condoms, may lead to over-demand, under-supply and systemic failures

slide5

Challenges to HIV Prevention

1) Limited information about the market of prevention supplies, including condoms, may lead to over-demand, under-supply and systemic failures

2) Limited availability of HIV counselling and testing services

slide7
3) Mixed and conflicting messages from donors and international partners

The ABC D isaster

The criticism of the content of AB is simple: the messages cannot be implemented by substantial parts of the population, they are not geared at real life. Abstinence is not an option for many (poor) women and being faithful does not protect against HIV/AIDS infection

Over the years, the A and B of the ABC tend to get a lot more emphasis than the C

Uganda case

Recent studies from Southern African Countries

slide8

Challenges to HIV Prevention

4) Forgotten (or neglected) areas:

- blood supply

- HIV transmission in health-care settings

- hard-to-reach and vulnerable populations, including sex workers, men who have sex with men and intravenous drug users

5) Scale up from small pilot projects with little impact and geographic coverage

6) Financial Gap

2005(Prevention): US$ 3.2 /5.7 (bi)

Prevention/Care needs: 15 bi/ 2006, 18 bi 2007, 22 bi/ 2008

slide9
Challenges to HIV Prevention

Some facts and wrong concepts

Alcohol consumption is linked to unprotected sex

The use of condom at sexual debut is infrequent, with females consistently less likely to report practice than males

Condom use is typically irregular, and very few youth report consistent and correct use of it

Sexually active youth express a preference for traditional methods, such as withdrawal and rhythm

slide10
Challenges to HIV PreventionSome facts and wrong concepts

Prevention targets difficult

Multisectoral and many partners

Prevention not as appealing

Stigma and Discrimination

"STIs/HIV can be prevented by good personal hygiene, and AIDS cured by medication"

"Condoms are unsafe"

slide11

Preventing HIV: What works

  • Preventing Sexual Transmission:
      • Behaviour change programs that encourage the use of condoms;
      • HIV testing and counselling;
      • Treatment of other STIs
      • HIV education
      • Circumcision (?)
slide12
Preventing HIV: What works

Preventing Blood Borne Transmission

Harm reduction programs for IDU including needle and syringe programs

Blood supply safety

Infection control in health care settings

Preventing mother-to-child transmission

Antiretroviral drugs

Breastfeeding alternatives

Cesarean delivery

slide13
Preventing HIV: What works

It is estimated that increasing access to effective hiv prevention could avert half of the 62 million new hiv infections projected to occur worldwide between 2005 and 2015

slide14
New prevention paradigms

• Paradigms that move from behavioral and

individual approaches and focus on collective

processes.

• That promote multisectorial responses through

alliances and partnerships and establishes coresponsibility of actions.

• That have a health and human rights perspective -

that promote nondiscrimination of persons living

with HIV, non discrimination of persons due to

sexual diversity, ethnicity, gender, age or drug

use.

Cristina Pimenta, Toronto 2006

slide15
New prevention paradigms

That promote and provide access to scientifically proven preventive measures.

That addresses the importance of linking prevention to treatment and care as part of an integral and integrated approach to prevention and health care.

• That promotes the combat of stigma and discrimination through provision of national legislature and implementation of local protective policies.

Cristina Pimenta, Toronto 2006

slide16
Challenges to HIV Treatment

Universal Access and Sustainability

antiretroviral therapy coverage in low and middle income countries june 2006
Antiretroviral therapy coverage in low- and middle-income countries, June 2006

Some numbers do not add up due to rounding - Source WHO

slide18

20 low- and middle-income countries in sub-Saharan Africa,

Asia, Latin America and the Caribbean treated

more than 50% of those in need, June 2006

slide19

Unmet need

70% of the total unmet need

5

Receiving ARV therapy

(Number of people in millions)

4

3

2

1

Latin America and the Caribbean

East, South and South-East Asia

Europe and Central Asia

North Africa and

the Middle East

Sub-Saharan Africa

ARV Therapy: global need, June 2006

slide20

Challenges to ART sustainability

1) Poor attention to ARV treatment follow up and transition to more complex regimens– we may not get a second chance!

  • 2) Burden of success: lower political engagement due to initial positive results from
        • - national governments AND
        • - civil society
slide21

Challenges to ART sustainability

3) Apparent affordability of antiretrovirals – pricing continues to be an issue:

  • Countries will increasingly switch to 2nd line drugs
  • Current 2nd line drugs may become 1st line regimens
  • Prices of “3rd-line” drugs may skyrocket (e.g., T-20)

4) Short-sighted perception that intellectual property right issues are no longer relevant

slide22

An example from Brazil

Apparent Affordability

Intellectual Property Rights

slide23

Average cost of ARV per patient/year (US$)

7000

6240

6000

5486

5000

4603

Introduction of

expensive

new ARVs

4000

3464

3000

  • Prices of second-line, patented drugs have stopped falling substantially
  • Number of people using them has increased dramatically

Thousands (US$)

2500

2210

2000

1500

1359

1336

1000

0

1997

1998

1999

2000

2001

2002

2003

2004

2005*

Year

slide24

Total expenditure (in US$ mi) in ARV procurement and average number of patients on antiretrovirals

450

200

395

180

400

336

160

350

305

303

140

300

120

232

250

224

203

Number of patients (thousands)

100

Expenditures (US$ mi)

181

179

200

80

150

60

100

40

50

20

0

0

1997

1998

1999

2000

2001

2002

2003

2004

2005*

Total expenditures (US$mi)

Average n. of patients (thousands)

Source: PN DST-AIDS/SVS/MS

* Data subject to revisions and modifications

slide25

Challenges to ART sustainability

5) Lack of long-term financial commitment from donors and recipients

6) Current mono/oligopolistic configuration of the market of active principle ingredients (API’s)

7) Lack of publicly-available, internationally-validated monographs and accredited laboratories for quality control

challenges to art universal coverage and sustainability
8-Prevention better than "cure”

Ensure prevention is not left behind

9-Chronic disease management

Beyond the numbers starting

Quality of care for life/Adherence

Person-centred care in the community

Challenges to ART universal coverage and sustainability
challenges to art universal coverage and sustainability27
10-Treatment of Opportunistic Infections

11- Children: Neglected patients

12-ARV Treatment for pregnant women

13-Tb x HIV

14-ITS x HIV

15-Counseling & Testing

Challenges to ART universal coverage and sustainability
the health sector s contribution to achieving universal access

S

T

R

A

T

E

G

I

C

I

N

F

ORMA

T

I

ON

Expanding testing and counselling

Maximising prevention

Accelerating treatment scale up

Strengthening health systems

The health sector's contribution to achieving Universal Access

(WHO)

slide29

Common Challenges

  • 1) Development of new technologies and systems

Technologies:

  • Prevention (e.g., microbicides, etc)
  • Treatment and care (e.g., new FDCs)
  • Vaccine

Systems:

  • Monitoring and Evaluation and Operational Research
  • Personnel (health and management)
  • Management

2) In a global resource-constrained environment, Latin America may be given ‘lower preference’

slide30

Some strategies to cope with these challenges

1 – South-South cooperation in technology-intensive areas

2 – Collective price negotiations

3-Clinton Foundation Approach

4-International Drug Purchase Facility (IDPF-UNITAID)))

5 – Local Production (TRIPS)