Transcript Progress in implementing the Thailand UN Response 2001

AIDS IN ASIA – PRIORITIZING AND
SUSTAINING THE RESPONSE
IN THE ECONOMIC CRISIS
Hanoi 28-30 September 2009
ADB Consultant
Ross McLeod
Presentation Outline
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AIDS in Asia
Funding for Prevention and Care
Vulnerability to the Crisis
Targeted Response is Key
ART Increases Program Costs
Response Publicly Financed
Summary
AIDS in Asia
• Most of the regional burden of
disease is found in India
• Countries such as Cambodia,
Thailand and Vietnam have
relatively higher prevalence’s
• Infection is concentrated amongst
most-at-risk-populations (MARPs)
• Injecting drug use, sex work and
unprotected sex amongst men
key drivers of Asian Epidemic
Vietnam
6%
Other
9%
China
14%
Thailand
12%
Myanmar
5%
Indonesia
5%
India
49%
Proportion of Asian Cases by
Country, 2007
Funding for HIV Prevention
and Care in 2007
• Funding for prevention and care has
increased from <$US 0.6 billion in
2004 to $0.9 billion in 2007
Vietnam
Thailand
Sri Lanka
• India and China accounted for around
40% of regional spending
Philippines
• Expenditure per person highest in
Thailand and Cambodia. Average
regional spending per person $US 0.3
Myanmar
Pakistan
Nepal
Prevention
Treatment
Laos
Indonesia
India
China
• Expenditure on prevention is greater
than treatment spending of around
$US 0.3 billion.
Cambodia
Bangladesh
0
100
200
$US million, 2007
300
Targeting of Response is Key
• Designing programs to minimize
HIV incidence and contain
treatment cost
• Focused response of Asia
Commission could prevent 80
per cent of new infections
• Of the current $0.9 billion for
AIDS prevention and care in
Asia, only <$0.1 billion is
targeting MARPs
• Inability to achieve behavioral
change amongst vulnerable
populations is underpinning
rising incidence
Resource Need for
MARPs
Available for MARPS
0
500
1000
$US million, 2007
1500
ART Increases Program Costs and
Financial Vulnerability
-Targeted package could reduce
number of people living with HIV
in 2020 by 3.1 million
8,000,000
HIV Cases
7,000,000
Baseline
Expanded
6,000,000
-Modeling suggests resources
needed for care will be $1 billion
more in 2020 for comprehensive
intervention
5,000,000
4,000,000
2019
2017
2015
2013
2011
2009
2007
2005
2003
-Without increase in MARP
coverage ART need will further
increase
2001
3,000,000
Limited Options for Diversifying
Financing of Programs
-Cost containment
imperative as:
•Prevention a public
good
•Care and treatment
user fees difficult to
implement and not
affordable
-ART high cost for all but
richest households
$US per year
30,000
Poorest
II
III
IV
Richest
25,000
20,000
15,000
ART Cost
10,000
5,000
0
Viet Nam
Thailand
India
Indonesia
China
Cambodia
Summary
• Prevention is Key
– Most at risk groups preventions for sex worker, client, MSM and
IDU most cost-effective. Coverage still very low.
– Need for accurate and timely data, especially for populations, which
are the drivers of the Asian epidemics
• Effective Prevention Reduces Longer Term
Costs
– Regional ART costs can be contained with effective prevention.
– Limited options to finance increased ART demand
– Containing cost enhances sustainability