2009 ECONOMIC AND SOCIAL COUNCIL
ANNUAL MINISTERIAL REVIEW
HIV in Latin America and the
Caribbean
Implementing agreed goals and
commitments
César Antonio Núñez - UNAIDS
Montego Bay, Jamaica, 5-6 June 2009
Halfway between UNGASS (2001) and the
Millennium Development Goals (2015)
HIV in Latin America and The
Caribbean
Overall figures – LA

HIV epidemic in Latin America remains stable overall, but
continues growing in vulnerable groups.

In 2007, new infections were estimated at 140 000 [88 000–
190 000]

Estimated number of PLWHIV is 1.7 millones

Of total PLWHIV, 44,000 are under 15 años

Approximately 63,000 individuals died of AIDS in 2007.
Overall figures – Caribbean

HIV Prevalence remains high among Men who have Sex with
Men, Male Sex Workers, Female Sex Workers, Crack
Cocaine Users, Prisoners, and Young People

In 2007, 20, 000 New HIV Infections occurred

Total of 230,00 people living with HIV from 210,000 in 2001

Adult HIV prevalence at 1.1% and increasingly affecting
females

14,000 people died of AIDS: leading cause of death in the 2544 years-old
HIV prevalence in Latin American &
Caribbean adults, 1990−2007
Estimated Adult HIV Prevalence in the Three Regions of the Americas.
UNAIDS/WHO, 2007
Caribbean
1.20%
North America
Latin America
1.1%
Prevalence
1.00%
0.80%
0.6%
0.60%
0.40%
0.20%
0.00%
0.5%
Millions
Number of people receiving antiretroviral drugs
in low- and middle income countries, 2002−2007
3.0
2.8
2.6
2.4
2.2
2.0
1.8
1.6
1.4
1.2
1.0
0.8
0.6
0.4
0.2
0.0
North Africa and
the Middle East
Eastern Europe and
Central Asia
East, South and
South-East Asia
Latin America and
the Caribbean
Sub-Saharan
Africa
end2002
end2003
end2004
Year
end2005
end2006
end2007
Estimated # of individuals receiving
ART, 2007
Geographical
Region
LAC
Est. #
receiving
ART Dec
2007
Est. #
needing ART
Dec 2007
ART
Coverage
Dec 2007
390,000
630,000
Latin America
360,000
560,000
64%
Caribbean
30,000
70,000
43%
Universal Access Report 2007 WHO June 2008.
62%
Number of HIV-infected children under 15
receiving antiretroviral treatment (2005–2006)
There was a 56%
increase in the
number of children
receiving ARVs in
LAC
Monitoring the Epidemic: Resource Tracking
Annual expenditures on HIV/AIDS in Latin America by
source, 2001-2006
1200
Domestic Public
Expenditures
Million US$
1000
800
Total International
(Excluding GF)
600
400
The Global Fund to
fight AIDS,
Tuberculosis, and
Malaria
200
0
2001
2002
2003
2004
2005
2006
División de Financiación y Economía del SIDA, ONUSIDA, 2008
Monitoring the Epidemic: Resource Tracking
Annual expenditures on HIV/AIDS in the
Caribbean by source, 2001-2006
250
Domestic Public
Expenditures
Million US$
200
150
The Global Fund to
fight AIDS,
Tuberculosis, and
Malaria
Total International
(Excluding GF)
100
50
0
2001
2002
2003
2004
2005
2006
División de Financiación y Economía del SIDA, ONUSIDA, 2008
The Three Ones Principles
Are we monitoring?
UNIVERSAL ACCESS
ONE National AIDS
ONE M&E System ONE HIV/AIDS
Action Framework
Coordinating Authority
Gaps and challenges in the
response to HIV
Under-addressed issues

Quality and availability of relevant data


Reporting against the UNGASS and Universal Access,
although improved, is not without notable gaps.
HIV, social vulnerability and risk-taking behaviours:




Women and HIV
Men who have sex with men (MSM) and transgenders
Sex workers (SW)
Injecting drug users:
‘Scratching the surface’ of integrated
development programming

While the interconnectedness among MDGs
is clear, it is not always evident that the
correlation of development issues finds its
way into cohesive, multisectoral development
programming and measurement.

Failure to routinely integrate strategies and
services to address undeniably
interconnected issues represents a lost
opportunity.
Care, Treatment and Support






Further integration into primary health care
services
Further integration of community care/support
services
Geographic decentralization of treatment
sites
Equity in treatment access
Close Gaps in coverage
Mind treatment costs
Stigma and Discrimination
“ ... In most countries, discrimination remains legal
against women, men who have sex with men, sex
workers, drug users and ethnic minorities. This must
change. ... [I]n countries with legal protection and
protection of human rights for these people ..., there
are fewer deaths. Not only is it unethical not to protect
these groups: it makes no sense from a public health
perspective. It hurts us all.”
Ban Ki-moon
UN Secretary General – August 2008
Institutional Response

Monitoring and evaluation

Availability of resources

Integrated Public Health Delivery Systems
The Way Forward:
Meeting the Internationally Agreed
Development Goals (IADGs)
Maintaining interest in HIV



Continue to provide community, national and
regional leadership and to keep HIV on
national and regional agenda
Maintain and/or increase, as far as possible,
current national investments in HIV (with a
focus on integrated development
approaches).
Stronger and more visible national leadership
on difficult challenges such as stigma
Maintaining strategic investment in HIV





Improved data
Right allocation of current and future investments:
Strengthening of Health Systems
Human rights and social justice programming
Strengthening programs to address social
vulnerability and risk:




Gender inequity
Most-at-risk populations
Prevention: increasing coverage and
comprehensiveness.
Improving and enhancing collaborative responses
for HIV/TB co-infection
Scaling up HIV Prevention

For each new person put on ART, two new persons
become HIV+

Combination HIV prevention programmes must be
widely implemented at country and regional levels






Biomedical interventions (ABC, Circumcision, STI prevention...)
Education programmes, including sexuality education in youth
Enabling environment interventions based on human rights
Legislations to stop all forms of criminalization related to HIV
Creating a movement of social change
Expanding access to treatment as a contribution to prevention
Take-home messages







Significant progress – but is it enough?
Prevention is lagging behind and needs
strengthening
Increasing progress on civil society involvement
Stigma and discrimination remain huge challenges
Sustainability of funding
Lack of strategic information
Strengthen political will