Critical Actions from 2012-2016 to Begin to End the HIV/AIDS Pandemic

An Action Agenda to End AIDS EMBARGOED Critical Actions UNTIL THURSDAY, JULY 19 AT NOON ET from 2012-2016 to Begin to End the HIV/AIDS Pandemic JULY 2012 ver the last year, the conversation about the AIDS transmission. We emphasize, too, that comprehensive • Focused, Evidence-Based Prevention Programs epidemic has dramatically changed. We’re now harm reduction, decriminalization and human rights for Key Populations—to ensure that drivers of O beginning to talk about how to end it. The hope protections must be combined to effectively address the the epidemic are addressed. stems from research breakthroughs as well as an epidemics among injection drug users, men who have accumulation of evidence on the potential impact of sex with men (MSM) and sex workers around the world. To end the epidemic, we cannot do everything in “combination prevention,” which the US government Failure to implement these strategies at scale remains every setting. Nor can we look to limited AIDS has defined as including voluntary medical male a major missed opportunity of HIV prevention to date. funding to address all the many ills that undermine circumcision, the use of ART treatment in HIV-positive health and development. Core interventions people to reduce risk of transmission prevention of As the concept of combination prevention takes should be complemented, where indicated by pediatric infections and HIV testing. hold, there will inevitably be debates about which local circumstances, by other strategies, such as “America’s combination prevention strategy focuses on a interventions to prioritize. We believe the test should condom promotion, harm reduction, behavior set of interventions that have been proven most effective To begin to end the epidemic, we need to be strategic be to identify the cost-effective approaches that will best change strategies, demonstration projects for pre- — ending mother-to-child transmission, expanding and ambitious in using what is available today. There reduce HIV incidence and AIDS-related morbidity and exposure prophylaxis and programs to address is evidence on the impact some of these core strategies mortality. Thirty years into the epidemic, we cannot underlying determinants of HIV risk. There are voluntary medical male circumcision, and scaling up can have when combined with other interventions. And afford—literally—to choose any other criteria for multiple agendas focused on protecting human treatment for people living with HIV/AIDS. Now of course, there is modeling that shows that these strategies, taken prioritizing our efforts. Available evidence indicates rights, addressing structural drivers, rights and interventions like these can’t be successful in isolation. to scale and with attention to key populations, will that the following core interventions meet this test and health of injection drug users, gay men and other They work best when combined with condoms, counseling reduce deaths, new infections and the price tag for the deserve to serve as the backbone of efforts to begin to men who have sex with men, sex workers and and testing, and other effective prevention interventions. AIDS epidemic over the long term. end the epidemic: : other key populations, and advancing reproductive And they rely on strong systems and personnel, including health rights and justice. These and many others trained community health workers. They depend on So there is agreement that the world can begin to end • HIV Testing—to dramatically increase the number are not captured explicitly in this document. They institutional and social changes like ending stigma; the epidemic. But there is an open and urgent question of HIV-positive and -negative individuals who know underpin it nonetheless. as to how? reducing discrimination against women and girls; their status early and access needed services. stopping gender-based violence and exploitation, which • HIV Treatment—to move to global implementation At this historic moment, all stakeholders need This report lays out a plan for beginning to end the AIDS to commit to a common goal. We must focus and continue to put women and girls at higher risk of HIV of ART guidelines that optimize treatment and epidemic. It includes clear time-bound outcome targets, hold ourselves accountable. And while working infection; and repealing laws that make people criminals as well as the responsibilities of different stakeholders prevention benefits. to deliver core interventions to broad scale, let our simply because of their sexual orientation.” to achieve these targets. • Voluntary Medical Male Circumcision—to achieve actions and investments continue to support the 80 percent coverage among adult males (ages 15-49) search for a preventive vaccine and a cure for HIV/ This plan focuses on scaling up a limited number of in 14 priority countries. AIDS, which will make permanent the favorable — US Secretary of State Hillary Clinton core interventions that will have the greatest impact and • Prevention of Vertical Transmission—to virtually changes that strategic action in the next five years November 8, 2011 offer the greatest value in epidemics driven by sexual eliminate new infections in children by 2015. will generate. 2012 2013 2014 2015 Make hard choices by prioritizing rapid and comprehensive scale-up of 9 million people on ART At least 11 million people on ART At least 13 million people on ART At least 15 million people on ART core interventions along with specific, rights-based approaches to reach No more than 1.3 million new HIV infections – a tipping point, as the num- populations at greatest risk. No more than 1.9 million new ber of new ART slots surpasses the number of new infections for the No more than 1.0 million new HIV HIV infections first time infections worldwide Mobilize sufficient, sustainable resources to ensure the rapid and No more than 280,000 new infections No more than 200,000 new infections No more than 100,000 new infections comprehensive scale-up of core interventions. in children and 65% PMTCT coverage in children and 75% PMTCT coverage in children and 85% PMTCT coverage At least 90% PMTCT coverage Agree on clear roles and responsibilities and hold one another accountable No more than 1.6 million AIDS No more than 1.5 million AIDS No more than 1.4 million AIDS No more than 1.2 million AIDS deaths and 20% fewer TB deaths deaths and 30% fewer TB deaths deaths and 40% fewer TB deaths deaths and 50% fewer TB deaths for results through agreed timelines, target outcomes, transparent reporting than in 2010 than in 2010 than in 2010 than in 2010 and real-time assessment of results. 80% coverage of VMMC in Build the evidence base to end AIDS by prioritizing implementation At least 4.7 million voluntary medical male circumcisions (VMMC) At least 60% coverage of VMMC in priority countries is within If we do this... supported by PEPFAR 14 priority countries research and the search for a preventive vaccine and a cure. immediate reach We can achieve this... We 20% of African countries achieve 40% of African countries achieve 60% of African countries achieve 100% of African countries achieve Use every resource as effectively as possible by lowering the unit costs Abuja Declaration Abuja Declaration Abuja Declaration Abuja Declaration of core interventions, improving program management and strategically At least $18 billion available for HIV At least $24 billion available for At least 10 countries pledge to programs, with at least 10 additional At least $20 billion available for HIV programs, including $4.7 billion targeting services. increase funding to Global Fund countries pledging to increase fund- HIV programs from the domestic public sector in ing to Global Fund sub-Saharan Africa 2 3 ENDING AIDS: Game changers YESTERDAY TOMORROW TESTING ABUJA DECLARATION NEW WHO ART GUIDELINES Build the evidence base to end AIDS Use every dollar of funding as effectively possible Mobilize sufficient, sustainable resources CONTINUED FUNDING OF PEPFAR Make hard choices 50% increase in percentage of populations Agree on clear roles and responsibilities hold one another accountable for results African Union countries pledge to spend Earlier initiation of ART, starting and full implementation of ‘‘AIDS-Free Generation’’ strategy of HIV-endemic countries that are aware of 15% of budgets on health at CD4 count of 350, up from 200 HARM HIV status and durably linked to high-quality GLOBAL FUND RESTORED REDUCTION 15 GLOBAL FUND prevention and/or treatment TO FINANCIAL HEALTH Implemented for AIDS, Tuberculosis HUMAN RIGHTS international donors replenish in 75% of countries & Malaria formed SOUTH AFRICA AIDS 50% fewer countries Global Fund RESPONSE SCALE-UP criminalize same sex EFFICIENT, EFFECTIVE PEPFAR government scales up provision behavior SERVICE DELIVERY 14 Launch of President’s Emergency of ART 80% of developing countries Innovative service provision Fund for AIDS Relief prioritize scale-up of core reduces to 10% or less the interventions VMMC CONSENSUS All 14 priority countries on track to achieve loss-to-follow-up at every stage on access to ART for all CHAI 80 percent VMMC coverage in men ages (testing, referral, retention) of Clinton Health Access Initiative negotiates treatment/prevention “cascade” 13 INCREASED INVESTMENTS 15-49 in the near future POLICY DECISIONS affordable prices for generic ARVs IN RESEARCH BOTSWANA NATIONAL for cure, vaccine and ART PROGRAM IMPLEMENT TREATMENT COMBINATION PREVENTION WHO 3 BY 5 INITIATIVE implementation science Data from impact evaluations sharpens national

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