Dr Socorro GrossGaliano Assistant Director Sustained Response to

Dr. Socorro Gross-Galiano Assistant Director Sustained Response to HIV: Financial Ministerial Meeting on HIV and Development in Latin America and the Caribbean ECOSOC - Annual Ministerial Review Jamaica, 4 -6 June 2009

Where does the financing for the response come from? HIV financing in selected countries Domestic Source: UNAIDS, 2008 ( last available year) We should sustain our support to countries with funding gaps and avoid setbacks on what we have already achieved International

Sustained Response to HIV: Financial Challenges What is the roadmap ? • Prevention (Young People / Risk Groups, Vertical Transmission) • Early Detection • Interventions that address the social and epidemiological reality • PHC based Health Systems with positive synergies • Mechanisms to improve interventions, efficiency and reduce costs • Strengthen inter-sector collaboration • Eliminate stigma and discrimination

Components of a Sustained HIV Response Health sector Provides important role of the response – leads inter-sectoral work, key for a sustained & comprehensive response.

Response should be maintained and expanded IT IS URGENT! Prioritize prevention reducing rate of new infections, targeting high -risk populations, work on stigma and discrimination and using resources üNew infections will require treatment üSizable number of infected people are still without access to treatment üPeople receiving ART will continue needing them ( more expensive plans)

For what? Estimates correspond to: ü ü Human Resources Materials Equipment Infrastructure Needed for the delivery of interventions that allow meeting of targets … Necessary to introduce mechanisms that reduce costs of providing services at all levels of the system and barriers to access - including out-of-pocket expenditures, stigma and discrimination the challenge is not limited to financial resources!

The financial crisis… Finds us with some of our health systems fragmented This has an impact on • The rational use of resources • The response capacity by the health sector … including HIV!

Reforms in the Re-orientation of PHC - based Health Systems HIV Universal Coverage Organizati on of Services Leadershi p Reform Public Policies Strong health systems = Robust response HIV is controlled, benefits are achieved, LIVES ARE SAVED

Progress on ARV Access to prevent mother to child transmission in LAC Impact on children: § Lack of opportunity from birth; § Vulnerability Social responsibility and of health systems % of HIV+ pregnant women that receive ARV for PMTCT § Deliver Social Protection § Cover treatment costs

Costs of not preventing Maternal-Child Transmission Cost of ART per child from 2 months to 15 years of age (US $) Prices Strategic Fund Prices negotiated without the application of international reference pricing The cost of treatment with ARV Cost preventing for 15 of years per a case of mother infected child varies to$25, 483 to child transmission $140, 222 (US)is estimated at US$500 ARV range Cost total in the Region: Cost can be minimized if prevention $313 million is & provided by an $ 1. 7 billions integrated (US) maternal care

Options to reduce and contain drug and resource costs US Dollars (US$) Purchase of ARV Two scenarios - Innovators (Chile) versus Generics (Peru), under the same centralized purchasing system

Difficulties in pharmaceutical markets

Coordination and intersectoral collaboration Now more than ever! Critical points in the intersectoral collaboration EDUCATION Monitoring the Inter-ministerial Declaration of Mexico at the national level LABOUR Links with the labor sector We need to invest in JUSTICE Protection of Human Rights collaboration & FINANCE & TRADE Protect public health & ensure equitable access to drugs & other products coordination CIVIL SOCIETY Coordination with civil society organizations SOCIAL SECURITY Include children orphaned by HIV

Recommendations

Recommendations

Recommendations

Recommendations

Recommendations

Recommendations

Recommendations AT ALL LEVELS! PROMOTE solidarity respect and the elimination of stigma and discrim

Thank You! ¡Gracias! Merci! Muito Obrigado!