Towards an improved investment approach for an

effective response to HIV

Dr Bernhard SchwartländerUNAIDS

We have done a lot …• Unprecedented scale up of services• Decline in rate of new HIV infections in many

countries • More than 6.5 M on ART

But we can do betterScale up to date guided by “commodity approach”• Unsystematic prioritisation and investment • Resources spread thinly across many parallel

interventions• Focus on discrete interventions rather than

overall results leading to a fragmented response

A shift in paradigm

Strategic investment based on prioritisation and driven by latest evidence

What can we achieve?

Universal Access by 2015

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

>500 350-499 250-349 200-249 100-199 50-99 <50

CD4 Count (cells/ml)

Cove

rage

ART coverage in 2015 by CD4 count

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

>500 350-499 250-349 200-249 100-199 50-99 <50

CD4 Count (cells/ml)

Cove

rage

13.1 million (health)

CD4 350

15 million (T4P)

Reaching people with services:Examples for 2015

CoverageCondoms (discordant couples) 60%Condoms (high risk pop) 50%Sex work 60%MSM programmes 60%IDU programmes 60%

MillionHIV testing 320ART 15

Return on investment:More than 12 million infections averted

0

500,000

1,000,000

1,500,000

2,000,000

2,500,000

3,000,000

2011 2012 2013 2014 2015 2016 2017 2018 2019 2020

New

HIV

infe

ctio

ns

Baseline Investment Framework

New infections averted between 2011 and 2020: 12.2 million

9

0

500,000

1,000,000

1,500,000

2,000,000

2,500,000

2011 2012 2013 2014 2015 2016 2017 2018 2019 2020

AID

S de

aths

Baseline Investment Framework

AIDS deaths averted between 2011 and 2020: 7.4 million

Annual number of AIDS deaths: 2011-2020

Life years gained 29.4 million

What will it cost?

What are the returns?

11

Resources needed

for the investment framework

0

5

10

15

20

25

2011 2012 2013 2014 2015 2016 2017 2018 2019 2020

Bill

ions

(US

$)

Synergies withDevelopment SectorsCritical Enablers

Behaviour ChangeProgramsMale circumcision

Treatment, care andsupportIDU

MSM

CSW and clients

Condom promotion

PMTCT

Economic cost and returns 2011 to 2020

Cost/ReturnsTotal additional investment (over 10 years) US$46.5 Billion

Future treatment need averted US$40 Billion

Life years gained US$1,060 per life year gained

Conclusions

• Through a focused and committed approach we can turn this epidemic around

• With an upfront investment over the coming 5 years, we will be able to turn cost around

• Time to overcome the false dichotomy between prevention and treatment

• In line with the commitments and targets included in the Declaration of the HLM AIDS

The Lancet Vol 377 June 11, 2011 - Available online at www.thelancet.com