Vraag 6: Wat kan er gedaan worden om de verspreiding van HIV in te dijken? Wat kan gedaan worden om het voorkomen van onbeschermde seks te verminderen? Welke andere maatregelen kunnen er genomen worden om de transmissie van HIV te verminderen/vermijden? Welke zijn de belangrijkste doelgroepen? In hoeverre zijn deze maatregelen succesvol gebleken?

Sexual behaviour change Behaviour change communication Making testing and counselling available Making condoms available

Males 15–24 years Females 15–24 years Source: Zambia Sexual Behavior Survey.

Multiple sexual partners in the past year, Uganda Source: Demographic and Health Surveys and other population-based behavioural survey data.

Condom use by men who have sex with men Source: Country Progress Reports 2010.

Reducing transmission efficiency Improve STI care Promote and offer male circumcision Post-exposure prophylaxis programmes (PEP) (Early ART; PrEP)

Combination prevention To no longer look for a ‘silver bullet’ that will halt the spread of HIV, but to combine all known strategies that reduce HIV transmission

Combination prevention ‘Biomedical’ interventions’, such as STI care, male circumcision, PEP, PrEP, etc. ‘Behavioural’ interventions’, such as BCC, T&C, condom programmes,… ‘Structural’ interventions’

Structural interventions for a sustained behaviour change Change the environment that leads to high risk behaviour, for example: Empowerment of women and vulnerable populations Legal and political environment Cultural perceptions Economic empowerment Mobility

Targeting the appropriate populations ‘Most-at-risk populations’ (MARP) Sex workers and their clients MSM IDU Youth Discordant couples

Condom use and HIV prevalence among sex workers in Cambodia

Other Integrate PMTCT in antenatal, maternity and postnatal care Blood safety programmes Making sterilised needles available

Coverage of antiretrovirals to prevent the mother-to-child transmission of HIV, 2008

Vraag 7: Wat kan/moet er gedaan worden om mensen die reeds geïnfecteerd zijn te verzorgen/ behandelen? Welke behandelingsopties zijn er? In hoeverre zijn die beschikbaar in OL? Wat kan er gedaan worden om die beschikbaarheid te verbeteren? Wat kan men doen om stigmatisering tegen te gaan en juridische en andere bescherming te verbeteren van personen met HIV?

Treatment of people with HIV Still no cure A combination of antiretroviral medicines can stop disease progression and prevent death Detection of HIV in TB patients and prophylaxis of TB in people living with HIV Home-based care and support

Treatment of people with HIV Initially ART too expensive for low-income countries Doha Declaration on the Agreement on the Trade-Related Aspects of Intellectual Property Rights and Public Health WHO launched “3 by 5” programme Rapid roll-out of ART

Treatment of people with HIV: Challenges Limited health systems capacity in low- income countries Heavily dependant on international support Imbalance with other health programmes Number of people needing ART continues to increase Adherence and drug resistance Low treatment retention rates

Adult retention in antiretroviral therapy in selected countries, 0–48 months, 2009 Source: WHO Towards Universal Access 2010

No matter how successful we will be in scaling up ART , We will not treat ourselves out of this epidemic!

Fighting stigma and discrimination Changing attitudes towards people living with HIV through sensitization activities Involvement of community leaders and influential people Involvement of PLWHA Creating a supportive legal environment

Countries with laws or regulations that create obstacles Overall South and Central America (19) Eastern Europe and Central Asia (11) South and South-East Asia (18) Sub-Saharan Africa (29) Western and Central Europe (8)

Vraag 8: Wat kan/ moet er gedaan worden om de gevolgen van de epidemie op de samenleving op te vangen?

Impact mitigation Social and economic support to people living with HIV and their families Support to orphans and vulnerable children Mitigating the impact on the national economy

Percentage of OVC receiving at least one type of support Source: Measure DHS

Vraag 9: Wat kan er gedaan worden om de bestrijding van HIV beter te organiseren, coördineren en op te volgen?

Evolutions in the response at national level At first: National HIV Programmes at the Ministry of Health Around 2000: shift to multi-sector approach: Establishment of National AIDS Councils Development of National Strategic Plans Integration in Poverty Reduction Strategies and other cross-sector programmes (MDG,..)

Response at international level 1987: WHO Global Program on AIDS 1996: Joint United Nations Programme on HIV/AIDS (UNAIDS) Begin 2000: The three ‘ones’: One national strategy to combat HIV/AIDS One national coordinating body One national monitoring and evaluation plan Multisectoral approach, involving all public sectors, the private sector and civil society

Response at international level (cont) 2001: U.N. General Assembly Special Session on HIV/AIDS (UNGASS) Global Fund to Fight AIDS, Tuberculosis and Malaria 2003: President's Emergency Plan for AIDS Relief (PEPFAR) 2005: WHO “3 by 5” initiative 2011: UN General Assembly High Level Meeting - Political Declaration on HIV/AIDS

2011 Political Declaration on HIV/AIDS Ten targets to be achieved by 2015 Getting to Zero - 2011–2015 Strategy Zero new HIV infections Zero discrimination Zero aids-related deaths New Investment Framework for the Global HIV Response

Main sources of funding At first, mainly bilateral through project funding Increased national funding Increased coordination among donors (Paris declaration) leads to less disperse funding: Shift to basket funding in the context of a SWAP Increased multilateral funding (Global Fund) USAID remains the major bilateral donor (PEPFAR) Reduction in international funding because of financial crisis

Rol van Belgie?

Trends over time, by sector (mio €) 0 € 5m € 10m € 15m € 20m € 25m € MULTI BI NGO et al. 2006 2007 2008 2009 2010

Proportion of the total ODA 2006-2009 (117,55 mio €), by Sector MULTI 71,1m € 61% BI 20,4m € 17% NGO et al. 26,0m € 22%

DGOS: HIV/AIDS-beleidsnota (transversaal) Doelstelling 1: aids bestrijden op basis van de mensenrechten Doelstelling 2: steun bieden aan het nationale aidsbeleid van de partners in het Zuiden Doelstelling 3: de internationale respons duurzaam verbeteren Doelstelling 4: doelmatige en doeltreffende interventies opdrijven Doelstelling 5: versterking van het Belgische draagvlak

Belangrijkste uitdagingen voor de toekomst Achieve better prevention of sexual transmission through the application of a combination prevention approach and a better targeting of MARP Maintain and augment the coverage of ART Better address stigma and discrimination Ensure continued funding