melbourne, 23 july 2014 - ias 2014 fatiha terki, wfp critical enablers and synergies including...
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Melbourne, 23 July 2014 - IAS 2014Fatiha Terki, WFP
Critical enablers and synergies including nutrition
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We will discuss…
• Investment framework• The role of critical enablers• How this apply to emergencies with an emphasis on
nutrition.• What is the role of WFP?
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35.3 million people were living with HIV in 2013: SSA, especially southern Africa, has the highest global burden of HIV 70.8%
Estimated number of people living with HIV (2012) and trends in the incidence of new infections from 2001 to 2012 by region
2014 UNAIDS Gap Report
HIV infection: epidemiology, pathogenesis, treatment, and prevention. Gary Maartens, Connie Celum, Sharon R Lewin, Lancet 2014. Online June 5, 2014 http://dx.doi.org/10.1016/ S0140-6736(14)60164-1
Source: UNAIDS 2013 report.
Using HIV as an entry point presents opportunities for collaboration and health system strengthening interventions that are FN sensitive
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The world of HIV and AIDS has changed…
• 31 M in 2002• 35.3 M in 2012
• Globally, 12.9 M people had started antiretroviral therapy at the end of 2013
• 5.6 M added since 2010 (33% in SA)
2014 UNAIDS Gap Report
HIV infection: epidemiology, pathogenesis, treatment, and prevention. Gary Maartens, Connie Celum, Sharon R Lewin, Lancet 2014. Online June 5, 2014 http://dx.doi.org/10.1016/ S0140-6736(14)60164-1
• 3.4 M in 2001• 2.1 M in 2013• Children’s new infections decreased by 58% from 580 000 (2002) to 240 000 (2013).
• 2.3 M in 2005 • 1.6 M by 2012• 1.5 M in 2013
Scale-up of treatment
Increased prevalence• people on ART are living longer
Decreased incidence
• Reductions in heterosexual transmission
• PMTCT Scale up
Decreased Mortality• people on ART are living longer
National investments have increased – Shared responsibilities and global solidarity
35% decrease since 2005
38% decrease since 2001
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- In line with the three zeros
- Compilation and analysis of evidence of interventions proven to reduce HIV risk, transmission, morbidity, mortality
- Models the investments required globally between 2011 and 2020 to revers the epidemic
…requiring prioritized investment approaches such as the UNAIDS investment framework
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UNAIDS investment framework focuses on high-impact and high-value strategies.
UNAIDS World AIDS day report, 2011UNAIDS/WHO The treatment 2.0 framework for action, 2011
Key elements of investment framework
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The investment framework recognizes social protection under synergies with development sectors
Source(s): Schwartlander et al., 2011 Lancet
Reduce RiskReduce the
likelihood of transmission
Reduce mortality and
morbidity
Critical Enablers – incl. nutrition support
PMTCT Condom promotion and distribution Key populations Treatment care and support to PLWH Male Circumcision Behavior Change programmes
Synergies With Development Sectorsincluding social protection
Basic Programme
Activities
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Critical enablers and development synergies are catalyzers for improved prevention, treatment care and support
1
2
UNDP, UNAIDS 2012 Understanding and acting on critical enablers and development synergies
Programme1
A
B
B
Food and Nutrition Support
Enabler for treatment care and support
May reduce mortality and improve adherence and retention in care
Government entities (National AIDS council and MoH) NGOs
HIV-sensitive
(HIV outcome
is one of many
objectives)
HIV-specific
(sole/primary
objective is an HIV
outcome)
Development
synergies
Critical enablers
2
1
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Development synergies - Why is social protection an important investment for HIV outcomes?
•Prevention: address the multiple social determinants of the epidemic – income inequalities, gender inequalities, social exclusion –and thus contribute to a reduction in new infections,
•Treatment: address demand side barriers to access HIV services with potential to improve prevention, treatment and care and support outcomes.
•Mitigation: mitigate the significant social and economic impacts of HIV and AIDS on households and individuals,
UNDP, UNAIDS 2012 Understanding and acting on critical enablers and development synergies
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Nutrition and food security play an important role in humanitarian responses and the HIV continuum of care
Individual
Health Systems
Community
ARTInfection Pre-ART
HIV continuum of care in Humanitarian settings D
eman
d a
nd
Su
pp
ly S
ides
Testing
PreparednessExpandedresponse
1 2 3 4
Role of Nutrition and Food
Security
Minimum response
Critical EnablersSynergies with Development Sectors
Source(s): WFP analysis
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WFP is the co-convening agency for HIV in humanitarian emergencies in the UNAIDS Division of Labour
UNAIDS Division of labour, 2010
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HIV
• Increased morbidity and mortality• Potentially negative coping behaviour that increases likelihood
of HIV transmission (e.g., unprotected, transactional sex)• Food insecurity may prevent people from seeking a diagnosis
and/or initiating and adhering to treatment
• Increased nutritional needs through metabolic changes• Reduced appetite and ability to take food• Reduced ability of body to absorb nutrients• Reduced access to food due to morbidity/low productivity
Food insecurity and malnutrition
Close relationship between HIV and food insecurity and malnutrition
Source(s): WFP analysis
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Food and nutrition
interventions
Treatment outcomes
Nutritional stabilization/recovery
Access to treatment
1
2• Nutrition Assessment,
Education, Counselling and support (NACS)
• Food supplements• Household support
• Faster weight gain (rebuilding of body tissues that were lost)
• Increased strength of immune system
• Increased drug effectiveness
• Reduced morbidity• Reduced mortality• Reduced transmission• Improved quality of life
• Increased treatment uptake• Increased treatment adherence
and retention in care
Food and nutrition supports treatment success by (1) facilitating nutritional recovery and (2) access to treatment
Source(s): WFP analysis
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WFP has significant expertise in food and nutrition programmes in the context of HIV
WFP supports 33 countries with HIV programmes
• Care and treatment: 68%• Mitigation and safety nets: 32%• ART adherence rates are over 80% in
significant proportion1 of programs
Total HIV/TB beneficiaries receiving support in 2013: 1,324,097
• HIV: 701,644• TB: 416,517• OVCs: 205,936
Technical advice to include F&N into HIV / AIDS national strategies, implementation plan, and protocols
Technical advice to include F&N into funding proposals (e.g., GFATM)
What is WFP’s role?
Adviser to government on nutrition integration into HIV policies &
programmes
Implementer of own programmes in line with government policies
(1) 73% of programmes reporting ART adherenceSource(s): WFP’s SRP Analysis – HIV and TB Programmes 2013
WFP is one of the few agencies working on demand side of HIV/TB, Nutrition, maternal and child health services during emergencies
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