New targets post 2015: Leave No One Behind
Jacqueline Makokha
UNAIDS, Regional Support Team, Eastern and Southern Africa
20 August 2014
HIV epidemic in the ESA region (2013)
Source: UNAIDS 2014
Number of people living with HIV
18.5 million
Number of children living with HIV
2.0 million
Number of new HIV infections
1.1 million
Number of new HIV infections
among children
120,000
Number of AIDS deaths
730,000
Number of people receiving ART
7.7 million
People living with HIV
25
Millions
20
2.0
15
1.5
10
1.0
5
0.5
Millions
0
1990
1995
2000
2005
2010
2015
New HIV infections
2.5
0.0
1990
1995
AIDS-related deaths
1.6
Millions
Millions
Overview of the HIV epidemic in the ESA region (2013)
1.4
2000
2005
2010
2015
People receiving ART
9
8
1.2
7
1.0
6
5
0.8
4
0.6
3
0.4
2
0.2
0.0
1990
1
1995
Source: UNAIDS 2014
2000
2005
2010
2015
0
2001
2003
2005
2007
2009
2011
2013
Overview of the HIV epidemic in the ESA region (2013)
PMTCT coverage
Thousands
90
80
70
450
400
350
60
300
50
250
40
200
30
150
20
100
10
50
0
2001
2003
2005
Source: UNAIDS 2014
2007
2009
2011
2013
New HIV infections among children
0
1990
1995
2000
2005
2010
2015
The importance of location and population
HIV prevalence among young women and men aged
15-24 years in East and Southern Africa in 2013
HIV Prevalence (%)
14.0
12.0
young women
10.0
young men
8.0
6.0
4.0
2.0
0.0
Source: UNAIDS 2014
HIV prevalence among South African boys and girls in
grades 9 and 10 in a rural district
Source: Kharsany, A. B., M. Mlotshwa, et al. (2012). BMC Public Health 12: 231.
Source: UNAIDS
Challenges: Key populations (PHID, MSM, FSW)
a substantial share of new infections
•
•
•
•
Swaziland
Mozambique
South Africa
Kenya (incl. prison pop)
Source: Gouws E, Cuchi P. Sex Transm Infect 2012;88:i76–i85
≈ 12%
≈ 20%
≈ 25%
≈ 30%
HIV prevalence among MSM in Africa
Ranging from:
6% in Cairo to
31% in Cape Town
Source: Griensven et al. Current Opinion in HIV and AIDS 2009
Global HIV prevalence among adult female sex
workers, 2013
Source: Beyrer, et al, The Lancet, 2014.
Percentage of adults (aged 15+) and children (aged 0-14) living with HIV
who were receiving ART in 2013, in 21 priority countries
Source:
UNAIDS
Source:
UNAIDS
2014
HIV treatment cascade for adults in sub-Saharan Africa aged 15 years or
more, 2013
Source: UNAIDS
Source: UNAIDS / UNICEF / WHO
Summary of the epidemic in ESA
Remarkable progress has been made in the region
–
–
–
–
Significant increase in ART and PMTCT coverage
Significant decline in AIDS deaths and in TB/HIV deaths
Important declines in new adult and child HIV infections
Funding support for the HIV response has been extraordinary
and has enabled countries to significantly expand their
responses
– Increased focus on improving effectiveness and efficiency of
the response
Population groups left behind
12 population groups left behind
•
•
•
•
•
•
•
•
•
•
•
•
Adolescent girls
Prison populations
Immigrants
People who inject drugs
Older people who are HIV+
Older people who do not think they are at risk
Sex workers
Transgender women
Children left behind on treatment
Women of reproductive age
HIV+ displaced persons
People with disabilities
Source: Human Sciences Research Council / Centers for Disease Control and Prevention / Human Rights Watch / Ukrainian Institute
for Social Research after Olexander Yaremenko and United Nations Office on Drugs and Crime
Source: UNAIDS / UNODC
New targets post 2015
Why new targets are needed
New targets are needed for four reasons:
1) Targets drive progress
2) New scientific evidence has emerged
3) New targets are needed to guide action
4) Bold new targets to end the epidemic
demonstrates that AIDS is a winnable fight
HIV Treatment access gap
Source: UNAIDS
Ending AIDS, leaving no one behind
• Too many people are left behind today – a challenge
• 12 populations left behind by AIDS response (Sex workers, men
who have sex with men; bisexual, transgender and intersex people; prisoners;
people who inject drugs; migrant workers, people with disabilities; and women and
girls)
• Need to address stigma and discrimination
• Close the gap between people who are reached with HIV
services and people who are not
• Require research and innovation combined with protective
laws
Thank you