Dr.-Birxs-presentation

Report
PEPFAR
Towards
an
AIDS-Free
Generation
……………………………………………………………………………
Women & Girls and HIV in PEPFAR
Ambassador Deborah Birx
Global AIDS Coordinator
US Department of State
September 9, 2014
History of the Epidemic & Response
Celebrating success and a call to action
Where we were before PEPFAR…
1991 – 2001:
Peak
of the
Pandemic
• 2001: Nearly 10,000 new HIV infections daily
• 2002: 50,000 on treatment in sub-Saharan Africa
• Health systems overwhelmed by the epidemic
• Life expectancy declines of over 20 years in some
countries
• Loss of working age population – reversing
decades of development progress
Unwavering Leadership from Congress
Demonstrated Commitment to Ending the AIDS Pandemic
2003
2008
2013
US Leadership
Against AIDS, TB,
& Malaria Act
Hyde-Lantos
Reauthorization
of PEPFAR
PEPFAR
Stewardship &
Accountability Act
Delivering an AIDS-Free Generation
Accountability
Transparency
Impact
PEPFAR Has Saved Millions of Lives
New Infections Halved since Peak of Epidemic
Trends in New HIV Infections, 19902013
1.4
North America
Western & Central Europe
Sub-Saharan Africa
1.2
Middle East & North Africa
Latin America
1
Eastern Europe & Central Asia
Asia & the Pacific
0.8
Caribbean
0.6
0.4
0.2
0
1990
1992
1994
1996
1998
2000
2002
2004
2006
2008
2010
2012
Leaving no one behind
Women face disproportionally high burden of HIV/AIDS
Key Populations Face a Significantly Higher Risk
of Acquiring HIV/AIDS
Young women
Sex work
People who inject drugs
Men who have sex with men
Transgender
Migrants
Prisoners
Displaced
Pregnant women
50+
Disabled
African American women
Intimate partners
Source: UNAIDS, 2014
Young women in Sub-Saharan Africa
are by far the largest group with a
disparately high risk of acquiring HIV
Disparately High HIV Prevalence among
Young Women Compared to Young Men
New HIV Infections in Sub-Saharan Africa by Age & Sex, 2013
Source: UNAIDS 2014
HIV Leading Cause of Death among
Adolescent Girls in SSA
In Eastern and Southern Africa, HIV is the leading
cause of death in girls aged 15-19
16.9
Source: Global Burden of Disease 2010
PEPFAR: Improving Outcomes for
Women & Girls
Women & Girls on Lifesaving Treatment
PEPFAR APR Results
Women & Girls on ART, 2010-2013
5,000,000
4,500,000
4,000,000
3,500,000
3,000,000
2,500,000
2,000,000
1,500,000
1,000,000
500,000
0
2010
2011
2012
2013
ACT: Accelerating Children’s HIV/AIDS Treatment
PEPFAR & CIFF
(the Children’s Investment Fund Foundation)
launched a
public-private partnership
to keep
Children &
Adolescents
alive and healthy
This $200 million initiative aims to
double the number of children on
treatment in at least 10 countries in
sub-Saharan Africa
With this initiative, we could avert an
additional 250,000 HIV-related deaths
of children under the age of five
• Additional HIV-related deaths
will be averted in the 5-15 year
old age group.
Maternal Deaths & HIV
Maternal mortality ratio, 2010
Every day
800 mothers die
due to pregnancy & childbirth
People Living with HIV by Region, 2011
WHO estimates that
18%
of all maternal deaths are
attributable to HIV
Source: WHO, 2011/2012
PMTCT: HIV Testing for Pregnant Women
PEPFAR APR Results
(PMTCT HTC, 2009 - 2013)
14,000,000
Over half of HIV+ pregnant women
in the world are tested and
identified with PEPFAR support
12,000,000
10,000,000
8,000,000
6,000,000
4,000,000
2,000,000
6.9%
7.9%
7.1%
0
2009
2010
2011
2012
Number of HIV Positive Pregnant Women Identified
Number of Pregnant Women Tested with Known Status
2013
PMTCT: Getting Lifesaving ART to HIV+ Pregnant
Women to Protect Maternal & Infant Health
In 2013, 56% of women
received lifelong ART, up
from 23% in 2011.
PEPFAR APR Results
(PMTCT ARVs 2009 - 2013)
1,000,000
900,000
800,000
700,000
600,000
500,000
400,000
300,000
200,000
100,000
0
2009
2010
2011
2012
Number of HIV+'P1.2.D HIV Positive Pregnant Women Identified
Number of Positive Women Receiving ARVs for PMTCT
2013
Saving Mothers Giving Life
An Innovative Public-Private Partnership
SMGL is bringing together key
partners…
To address the 3 delays that
contribute to maternal mortality:
Delay in decision to
seek care
Delay in reaching
care
Delay in receiving
quality health care
SMGL Phase 1 Results:
Institutional Maternal Mortality Declined in both Uganda & Zambia
Uganda
Zambia
Maternal deaths per 100,000 live births
600
350
534
500
400
300
310
300
- 35%
345
416
250
- 35%
200
- 35%
203
260
- 36%
167
269
150
200
100
119
76
100
0
50
50
36
0
MMR
Direct MMR
Baseline
Endline
Indirect
MMR
Percentage declines noted are statistically significant
MMR
Direct MMR Indirect MMR
Baseline
Endline
Pink Ribbon Red Ribbon
Public-Private Partnership to Combat HIV & Cervical and Breast Cancers in Africa
• Cervical cancer – one of most common cancers
among women in developing world
– 275,000 deaths each year
– >85% global burden in developing countries
• $85 million over 5 years currently committed
• Zambia and Botswana are initial PRRR countries
HIV-infected women
– Major expansion of “screen and treat” programs
– Pilot programs for HPV vaccination
– Training for breast cancer awareness and CBE
have a
significantly higher risk
of acquiring
cervical cancer
• Founding PRRR members include:
–
–
–
–
–
PEPFAR
The George W. Bush Institute
Susan G. Komen for the Cure
UNAIDS
Multiple private sector partners
PEPFAR Gender Strategy
– Increasing gender equity in HIV/AIDS
programs and services, including
reproductive health services
– Preventing and responding to genderbased violence
– Engaging men and boys to address
norms and behaviors around
masculinity and sexuality
– Increasing gender-related policies and
laws that increase legal protection
– Increasing gender equitable access to
income and productive resources,
including education
in the past four years,
PEPFAR reached over
114,000
survivors of
sexual violence
with post-exposure
prophylaxis to prevent
HIV
Mitigation as Prevention: OVC Programs
Impacts of social protection on girls’ past-year
incidence of transactional sex
12
Transactional sex incidence
(past-year) Not on benefit
10
Transactional sex incidence
(past-year) Maintained on
benefit
8
6
4
2
0
Any grant
Child-focused
grant
Free school
Free school
meals
Together for Girls
A Unique Public-Private Partnership
Our work is not done. This week alone…
Over 3600 children died
this week from HIV
Over 25,000 adults died
this week from HIV
Over 4,600 babies were infected
with HIV
Over 36,500 adults were infected
of which more than 7000 were
young women
PEPFAR
THANK YOU

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