STRATEGIC PLAN 2011-2015
Joint United Nations Programme on HIV/AIDS (UNAIDS)
Revised Second Draft—For Comment
6 October 2010
Contents
Foreword 5
Foreword by Michel Sidibé will be inserted here. 5
UNAIDS Mission 6
The Plan – At a glance 7
I The rationale for a new strategic plan: accelerating progress towards universal access 8
II Overview of the Plan 13
III UNAIDS Strategic Directions 2011-2015 15
Strategic Direction 1: Revolutionise HIV prevention 15
Strategic Direction 2: Catalyze the next phase of treatment, care and support 21
Strategic Direction 3: Advance human rights and gender equality for the HIV response 27
IV Core themes guiding UNAIDS action 30
Increased focus on country ownership and sustainability of the HIV response 30
People at the centre of the response 31
HIV synergies with broader MDG and human development efforts 32
V Delivering results 33
Strengthening joint working 34
Practising more strategic partnership 35
Enhancing technical support 41
Enhancing knowledge translation and the generation and use of strategic information 42
Implementing the Plan, measuring progress and improving accountability 43
Mobilizing financial resources for the HIV response and the Joint Programme 44
Organizational change for a more effective Joint Programme 46
References 47
List of acronyms
DOL / Division of Labour
GIPA / Greater Involvement of People living with HIV
ILO / International Labour Organization
M&E / Monitoring and Evaluation
MDGs / Millennium Development Goals
PEPFAR / US President’s Emergency Plan for HIV/AIDS Relief
PHDP / Positive Health, Dignity and Prevention
PLHIV / Person/people living with HIV
RC / United Nations Resident Coordinator
RST / Regional Support Team
TB / Tuberculosis
TRIPS / Trade Related Aspects of Intellectual Property Rights
UBAF / Unified Budget and Accountability Framework
UBW / Unified Budget and Workplan
UCC / UNAIDS Country Coordinator
UNAIDS / United Nations Joint Programme on HIV/AIDS
UNCT / United Nations Country Team
UNDG / United Nations Development Group
UNDP / United Nations Development Programme
UNESCO / United Nations Educational, Scientific and Cultural Organisation
UNFPA / United Nations Population Fund
UNGASS / United Nations General Assembly Special Session
UNHCR / United Nations High Commissioner for Refugees
UNICEF / United Nations Children’s Fund
UNODC / United Nations Office on Drugs and Crime
WB / World Bank
WFP / World Food Programme
WHO / World Health Organisation
Foreword
Foreword by Michel Sidibé will be inserted here.
UNAIDS Vision
Zero new infections. Zero discrimination. Zero AIDS-related deaths.
UNAIDS Mission
The Joint United Nations Programme on HIV/AIDS (UNAIDS) represents an innovative collaboration involving ten United Nations Cosponsors[1] and the UNAIDS Secretariat. UNAIDS’ strength derives from the diverse expertise, experience and mandate of its Cosponsors and the added value of the Secretariat in leadership and advocacy, coordination and joint accountability. UNAIDS’ mission is to lead and inspire the world in achieving universal access to HIV prevention, treatment, care and support by:
§ Uniting the efforts of the United Nations system, civil society, national governments, the private sector, global institutions and people living with and most affected by HIV;
§ Speaking out in solidarity with the people most affected by HIV in defence of human dignity, human rights and gender equality;
§ Mobilising political, technical, scientific and financial resources and holding ourselves and others accountable for results;
§ Empowering agents of change with strategic information[2] and evidence to influence and ensure that resources are targeted where they deliver the greatest impact and bring about a prevention revolution; and
§ Supporting inclusive country leadership for sustainable responses that are integral to and integrated with national health and development efforts.
The Plan – At a glance
Our global commitmentsAchieve Universal Access to HIV prevention, treatment, care and support by 2015 / · / Halt and reverse the spread of HIV and contribute to the achievement of the MDGs by 2015
Our strategic directions / Our goals
Revolutionise HIV prevention
7400 people are newly infected with HIV everyday. UNAIDS aims to revolutionise HIV prevention efforts by catalysing social movements, led by people living with HIV, affected communities, women and young people, to shift social norms that exacerbate vulnerability to HIV and to generate political incentives to finance and deliver the appropriate combination of biomedical, behavioural and structural interventions. UNAIDS will enable communities to demand, design, implement and evaluate effective prevention options. UNAIDS will help countries to deliver equitable access to quality, innovative and cost-effective HIV prevention programmes that are suited to the epidemic context and people’s needs and rights to prevent HIV infection. / / To get to Zero New Infections
Eliminate mother-to-child-transmission of HIV
Reduce sexual transmission of HIV
Prevent new cases of HIV among people who use drugs
Reduce new infections among young people
Catalyse the next phase of treatment, care and support
2.7 million people died from AIDS-related causes in 2009. UNAIDS will promote national and global commitment to the achievement of universal access to treatment, care and support through more effective, ethical, affordable and sustainable approaches to treatment and service delivery. UNAIDS will support communities to demand, design, implement and evaluate treatment, care and support services, to identify and dismantle barriers to testing, treatment and adherence, and to strengthen social protection, nutritional, economic, and other support and forms of care for people living with and affected by HIV including orphans and vulnerable children. / / To get to Zero AIDS-related Deaths
Ensure all people living with HIV in need receive treatment
Reduce the number of deaths due to TB among people living with HIV
Enhance social protection for people affected by HIV
Advance human rights and gender equality for the HIV response
Despite the commitment of governments to protect human rights and promote gender equality, discrimination and other forms of human rights abuses continue while legal and social barriers block an effective HIV response. UNAIDS will intensify its support to governments to realize and protect human rights in the HIV response, reach the most deprived and vulnerable communities, promote supportive laws and the removal of harmful laws, promote the rights of women and girls for gender equality, address gender-based violence, and support communities to demand their rights and challenge risky and harmful social, cultural and gender norms. / / To get to Zero Discrimination
Remove punitive laws that block the HIV response
Empower people at risk to protect themselves from HIV and access treatment
Meet the needs of women and girls and end sexual and gender based violence
Our guiding themes / Focus on country ownership and sustainability / People at the centre of the response / HIV synergies with broader MDG and human development efforts
I The rationale for a new strategic plan: accelerating progress towards universal access
The past decade has seen a significant increase in the political and financial commitment to address HIV, while the HIV movement has resolutely demonstrated its ability to transform resources into concrete results for people.
The year 2010 was marked by UN member states for the ambitious aim of achieving universal access to HIV prevention, treatment, care and support, and progress has been significant. Globally, the number of new HIV infections declined by 17% between 2001 to 2008.[i] An estimated 5.2 million people in low- and middle-income countries now receive life-prolonging antiretroviral therapy, compared with 400,000 in 2003—an increase in access from less than 1 in 20 people living with HIV in need of treatment to 1 in 3. Between 2004 and 2008, annual AIDS-related deaths decreased from an estimated 2.2 million to 2 million—as opposed to the 2.6 million deaths that would have occurred in 2008 without treatment.
However, 2.7 million people were infected with HIV in 2008. And although 5.2 million people have access to treatment, this is only one-third of the estimated 15 million people living with HIV in need of lifelong, effective HIV treatment today.[ii] New infections continue to outpace access to treatment, with five people newly infected for every two who start treatment. In 2008, an estimated 33.4 million people were living with HIV, including 2.1 million children below the age of 15.[iii]
By the end of 2010, the world remained far from reaching its goal of universal access. Four out of five low- and middle-income countries were not on track to meet the universal access targets they had set.[iv]
1 The need to face and overcome the real barriers
The significant barriers that impede countries’ progress are manifold. While national governments have made impressive commitments to defend human rights and provide a protective legal environment for people living with HIV and people at higher risk of exposure, much less has been achieved in realizing these commitments. In some cases, laws have even been passed to criminalize HIV transmission—a legal measure not undertaken for other transmissible diseases such as hepatitis, Chlamydia or herpes. Persistent gender inequalities and widespread discrimination, injustice and brutality put women and girls at greater risk of HIV throughout the world.
Effective HIV responses must be led by people living with and affected by the epidemic. The remarkable gains to date are largely the result of their activism and mobilization. However, where stigma, discrimination, gender inequality, gender-based violence and other human rights abuses persist, the very people most central to shaping better responses to HIV are the criminalized, marginalized, disempowered and dying.
Inadequate progress, hampered by these challenges, reinforces the need to reshape the response in several ways: by rethinking and vastly scaling up approaches to HIV prevention; by identifying simpler and less costly treatment regimens; and by tackling stigma, discrimination and gender inequality that increase vulnerability to HIV infection and its impact. Reaching universal access calls for renewed impetus, increased and predictable funding from innovative and existing sources and the renewal of leadership and activism in the HIV response.
2 The need to respond to diverse and evolving epidemics
Accelerating progress towards universal access means responding to evolving epidemics based on our constantly increasing knowledge about their dynamics. The current diversity of HIV epidemics—which can differ by region, mode of transmission and impact—is considerably more complex than current responses.
Throughout sub-Saharan Africa, HIV is mainly transmitted through heterosexual sex. While heterosexual sex with one partner is traditionally considered “low-risk,” high infection rates among women reflect the need to better target prevention programmes to address the needs of women engaged in serodiscordant and concurrent sexual relationships.[3] Such programmes are currently weak and inadequate.
Most new infections in Asia and the Pacific result from unprotected paid sex with female, male and transgender sex workers,[v] while in some countries in South Asia, epidemics are emerging among couples in stable, long-term relationships as a result of men having unprotected sex with sex workers.[vi] In Eastern Europe and Central Asia, HIV has been largely concentrated among people who use drugs, but it is now spreading to their sexual partners.[vii]
HIV epidemics vary from region to region, country to country, and within countries. Putting into practice the framework of “Know your epidemic, know your response,”[4] based on understanding and responding to the local specifics of an epidemic, has significantly improved countries’ knowledge of the nature of epidemics and responses, and is increasingly translated into better national AIDS responses. However, if policy making, resource allocation and programming are to adequately reflect the local context and epidemiological dynamics, as well as address the needs of people at higher risk of HIV infection, much more is needed. Political commitment to evidence-informed responses must be strengthened, and up-to-date strategic information on how and why people are contracting HIV—including the influence of social, political, economic and legal environments—must be improved.
3 The need to respond to a changing environment
The remarkable gains of the HIV response can not be guaranteed. Changes in the wider environment—most notably the global economic crisis—have serious implications for sustaining and strengthening the HIV response. The upward trend in resources flat-lined in 2009, and in a number of countries, treatment programmes were unable to accept new clients, or in the worst cases were cut back. Funding constraints could jeopardise what has been achieved and impede future efforts to achieve universal access.
The HIV response will be affected by trends in the global political-economy; for example, by the continued rise of emerging economies and the shift from a G8 to a G20 world. The way UNAIDS manages the opportunities and challenges arising from this shift will significantly affect whether our goals are met. More strategically, the increasing clout of emerging economies in global negotiations on trade, development, human rights, intellectual property rights and other issues will have profound implications for many drivers of HIV and the response. The historic role of the BRICS countries (Brazil, Russia, India, China and South Africa) in relation to TRIPS[5] and essential medicines is a potential boon for the HIV response. UNAIDS must work with allies within the G20 to adopt an explicit development agenda including commitment to universal access.
4 The need to unite our efforts
There is growing international recognition that, in many countries, other Millennium Development Goals (MDGs) cannot be achieved without tackling HIV. At the same time, as the 2009 report of the UN Secretary-General noted, an effective and sustainable HIV response depends on wider health, development and human rights efforts.[viii]
AIDS-related illnesses are a leading cause of mortality in women of reproductive age, and almost one in every five maternal deaths worldwide in 2008 was linked to HIV.[ix] In six hyper-endemic[6] countries, AIDS is responsible for over 40% of child mortality.[x]
HIV also can have dramatic consequences for entire communities. The majority of people dying from AIDS-related illnesses are young adults—among the most economically productive members of society. Despite increases in access to treatment, the number of children orphaned as a result of HIV continues to increase. Across the world, 17.5 million children are estimated to have lost at least one parent to HIV. Loss of income, treatment and hospitalization and providing care for family members living with HIV and orphans results in a high economic burden for households.[xi]