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

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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

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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

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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

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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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