What are the costs? What’s new and what’s the opportunity? What should we say about it?

1. Ending AIDS: what will it take? What are the costs? What’s new and what’s the opportunity? What should we say about it?

2. Political Declaration on HIV/AIDS 2011: resources for the HIV response • Close the global resource gap by 2015 • $8 billion annually, overall target $24 billion • Support and strengthen existing financial mechanisms • including the Global Fund and relevant UN organizations • Programmes must become more cost-effectiveand evidence-based and deliver better value for money • Break the upward trajectory of costs through theefficient utilization of resources • Simplify treatment regimens and delivery (Treatment 2.0) • Integrate HIV programmes with other areas of the health system • Expand voluntary and additional innovative financing mechanisms

3. Global HIV Funding Needs (based on current HIV clinical eligibility criteria)

4. Funding for HIV in low- and middle-income countries, 2002–2011

5. Global HIV Investment Needs: $24b annually by 2015 US$ billion Previous projections UNAIDS Investment Framework Business as usual

6. Donor and National Investments in HIV Prevention among Key Populations Source: Global AIDS Response Progress Reporting country reports (most recent available).

7. Spending smarter and more strategically Investment categories: High-level, directional guidance • Target HIV investments to: • Ensure bulk of funding is spent on basic programs. • Invest in social and programmatic ‘Critical Enablers’ to ensure robust and sustainable response. • Invest in HIV-related interventions that support development goals. Illustrative Program areas: Specific benchmarks tied to different epidemics Evidence-based interventions that target the source of new infections and effectively reduce morbidity and mortality. Illustrative

8. What are the opportunities?

9. A real pivot point: ending the AIDS crisis through accelerated scale up of treatment, combination prevention Halting disease progression—people living successfully with HIV and accelerated declines in HIV incidence Quality disease control programs (decentralized, community owned, better linkage, better adherence) delivering less toxic, more durable, easier to take regimens Massive scale up of combination HIV prevention Leveraging dramatic prevention benefits of ART—including with earlier treatment initiation Improved vertical transmission prevention regimens (Option B/B+) Scaled up HIV counseling & testing Policies, laws and programs that defend, protect and promote human rights of people with HIV and those at greatest risk of infection Condoms Safe medical male circumcision Clean injecting equipment, oral substitution therapy Virtually no children born with HIV infection

10. 2011 Political Declaration: key targets for 2015 Reduce sexual transmission by 50% Reduce transmission of HIV among people who inject drugs by 50% Eliminate mother-to-child transmission and substantially reduce AIDS-related maternal deaths 15 million people living with HIV on antiretroviral treatment Reach a significant level of annual global expenditure (between $22-$24bn) in LMICs

11. 2011 Political Declaration: key targets for 2015

12. Target 6.B:Achieve, by 2010, universal access to treatment for HIV/AIDS for all those who need it 35 30 21 10 10

13. Ending the AIDS crisis through accelerated scale up of treatment, combination prevention With acceleration, Zambia would be able to avert a total of over 126,000 HIV infections 2012-2016, compared to baseline. • Combination prevention + earlier access to tx would avert 179,200 new HIV infections—a 57 percent decline in incidence—over a four-year period, with 118,000 additional deaths averted. Source: PEPFAR Blueprint for an AIDS Free Generation, December 2012

14. Ending the AIDS crisis through accelerated scale up of treatment, combination prevention Through scale up at CD4<350 Kenya could avert 222,600 new HIV infections and 159,900 by 2016 compared to baseline Through scale up at CD4<550, 333,300 new HIV infections and 258,000 AIDS-related deaths could be stopped by 2016 Source: PEPFAR Blueprint for an AIDS Free Generation, December 2012

15. Spending more now expands coverage and reduces costs in the near term Source: PEPFAR Blueprint for an AIDS Free Generation, December 2012

16. Important developments coming… The denominator of people with HIV eligible for treatment will change (launch of WHO 2013 consolidated ART guidelines at 2013 IAS meeting in Kuala Lumpur) Recommendations on strengthening ART monitoring (introduction of viral load) These changes have consequences for global need numbers, national plans, and Global Fund resource requirements

17. Advocacy messages: for discussion We can defeat these epidemics—through massive scale up of life saving services, building on extraordinary momentum The “tipping point” in the fight against AIDS is here: we cannot afford the consequences of slowing down AIDS is far from over but we know what we need to do to end it and have the tools We must aggressively confront the barriers that obstruct access to services—including discriminatory laws, deadly inequities, failing health systems, and community responses that are starved for funding Shared responsibility and global solidarity for the AIDS response are essential