Dr. César Núñez
ONUSIDA RST LA
Global Health Sector Strategies for HIV, STI and Viral Hepatitis
14 April 2015
OBJECTIVES
 Provoke a discussion on regional priorities
 Determine what needs to be done differently in
the response to achieve our ambitious aims for
2021
 Inform the Global Consultation in Geneva, 23-24
April
Why a six-year Strategy?
 Implements the Fast-Track initiative
 Positions Strategy to again be seminal reference for
2016 HLM
 Aligns with planning cycles of other funds and
programmes, as mandated by the quadrennial
comprehensive policy review
 Reduces transaction costs
Parameters of Strategy Update
 Extension of current Strategy
 Retain zeros, strategic directions, goal architecture
 Update to account for
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Changing geopolitical and development context
Urgency to implement Fast-Track strategy
New evidence on who is being left behind in Gap Report
Getting granular—sub-national
Regional focus on priorities, ambitions and game-changers
 Strategy will be developed in parallel with UBRAF
By 2020
•
By 2030
Other targets aim at reducing the number
of new HIV infections per year to 500,000
by 2020 and to 200,000 by 2030 as well as
reaching zero discrimination
1,2 million infections averted
700 thousands deaths averted
6
Consultation process in LA
UCRG Meeting 23-24 February in Panama
Regional stakeholders meeting in Panama 26 February
Regional UNAIDS and open regional webex 10 and 17 March
Subregional webex (Central America, Andean Region, Southern Cone) 17-19 March
High-level meeting webcast 24 March
Consolidation and inform Geneva for meeting on 23-24 April
REGIONAL CONSULTATION LATIN
AMERICA – RESULTS
Trends to impact on HIV and the
response
ECONOMIC
• Fast economic growth
• ▼oil prices
• Inequalities in MICs
• Contraction of international aid
and low South-South
cooperation
• Sustainability at risk
CIVIL SOCIETY
• Increasingly effective
participation
• Advocacy decreasing
• Weak links with gov’ts
HIV AND HEALTH SYSTEMS
• Higher life expectancy
• Adherence increasing
• Incidence in young people
• Limite discussion on combined
prevention
POLICY
• Lack of high-level political commitment
• HIV fades in wider health agenda
• Conservative ideologies put achievements at risk
• Respect for LGBT rights but restrictions on sex
work and drug use
• Structural barriers to key populations
• Decentralization process
• UNAIDS Strategy should place LA at core if meant
to be global
SOCIAL
• Social protection policies in several countries
• Tensions between HR’s and multiculturalism
• Culturally-embedded machismo
• High violence and GBV
• International and internal economic migration
• Changes in drug use
Achievements to build on
Incipient HIV
national
budgets.
South-South
cooperation
Rightsprotective
laws.
CS advocacy.
▲access to ART.
▲condom use.
▲ adherence.
▼ MTCT.
Friendly services
HIV/SHR integration
VIH/TB collaboration
M&E systems.
Community systems.
Recognition of
the role of
people with HIV
and key
populations
CHALLENGES
GAPS
Appropriation of national response
Lack of political commitment and
intersectorality
Universal ART, testing and adherence – rural
and marginalized populations in services
Weak health and community systems – Vertical
programmes
Granulating strategic information
Reaching new actors (BRICS)
Human rights-based regulations
Participation of local and regional networks
Using TRIPS exceptions – prices comparable
among countries
Identification and use of technologies for
prevention and treatment
Regional and sub-regional integration to
strengthen cooperation and optimize
resources
Local and focused knowledge and action
Overcome stigma and discrimination, homoand transphobia, and harmful social gender
norms
Criminalization of HIV
ART and commodities stock-outs
Populations left behind
Children and adolescents
Youth
Transgender, MSM and sex workers
Women
People with HIV
Prisoners
Drug users
Migrants
Indigenous populations
Priority strategies
POLICIES
Strengthening of political commitment at all
levels
Guarantee of respect for human rights
Promotion of intersectorality, including social
protection
Strengthening of civil society – government
articulation
Guarantee of sustainability with domestic
resources
SERVICES
Enhance prevention in key populations
Implementation of innovative prevention
methodologies
Disaggregation of strategic information
Making treatment and diagnosis universal
Implementation of comprehensive approach
to adherence
CIVIL SOCIETY
Renew leadership
Involvement of key populations in care
Making CS work sustainable
Game-changers
•
1) Policy and law reform
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Political commitment – accountability
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Positioning of Latin America in the global response •
Legal barriers to testing in adolescents
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Criminalization of HIV and sexual behaviors
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Use of TRIPS exceptions
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Human rights violations – antidiscrimination laws •
Regulation of sex work
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2) Funding
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6) Civil society
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Guarantee of sustainability
South-South cooperation
Monitoring of expense quality
Public-private alliances
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Empowerment and articulation
Strong advocacy
Social audit
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3) Resource allocation
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7) Science and innovation
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Funding for co-infections
Resources to key populations
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PMTCT
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Resources to disaggregated strategic information •
Resources for sexual education
Access to new prevention technologies
Anthropological studies and operational research
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4) Partnerships
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Integration with sexual and reproductive health
Intersectorality (Education, Labour, judiciary)
5) Services delivery
Services for key populations
Training of health personnel
Universal access to services – barriers
Service quality
Easy access to testing
Monitoring loss of patients
Decentralization of services
8) Link with other development efforts
Multisectorality (education and labour)
Social protection for people with HIV and key
populations
What could/should the Joint UNAIDS
Programme do?
• Review the Division of Labour to avoid competition and promote
synergies.
• Support to significantly reduce new infections. The baseline must be
known.
• Expand achievements in treatment. Test and treat. Reduce ARV prices
using TRIPS regulations. Scale-up of programs for promotion of adherence.
• Recall the leading role of governments and the importance of
accountability and responsibility in the protection of human rights.
• Strengthen systems for collection and dissemination of granulated
strategic information..
• Redesign health- and other systems integrate civil society in service
provision.
THANK YOU
For more information visit ONUSIDA Latina web page:
http://www.onusida-latina.org/es/noticias/766-consulta.html