Remarks by UNAIDS Executive Director, Michel Sidibe

Michel Sidibe, Executive Director, UNAIDS
Session on “Consideration of Reports: Abuja Call for Accelerated Action Towards Universal Access to HIV/AIDS, Tuberculosis and Malaria by 2015, Assessment Report 2013”

Summary
Call for ending the AIDS epidemic (in Africa) by 2030 by ensuring zero (preventable) AIDS deaths, and zero new HIV infections among young women and zero sexual violence.

Introduction
Congratulate H.E. Mustapha Sidiki Kaloko, AU Commissioner for Social Affairs, for a detailed and enlightening presentation on the Assessment Report. Acknowledge the leadership of the African Union to the AIDS response on the continent and commend the achievements by the Member States.

Despite despair, Abuja 2001 was catalytic moment for change. ARVs cost $10-15 thousand a year, and the question was whether Africans could be put on treatment. Efforts that started here in 12 years ago largely shaped the UNGA Special Session on AIDS in 2001, led to the creation of the Global Fund in 2002, and the US government established the PEPFAR programme in 2003. In line with Shared Responsibility and Global Solidarity, Africa’s contribution to the AIDS response has increased by 140% over the time.

Today almost 10 million people worldwide are receiving antiretroviral therapy, 7.5 million of them in Africa South of the Sahara, and this represents more than a 150 fold increase in 12 years. The annual number of people dying of AIDS-related causes fell by 32% from 2005 to 2011 in Africa South of Sahara. 35 countries on the continent have stabilized or recorded a decline in new infections, and much progress has been achieved in reducing HIV infections from MTCT.

The future
But AIDS is not over yet. Unfinished Business is a metaphor for inequality. People with HIV are accessing medicines and leaving normal productive lives in the developed world. Why should Africa have almost 90% of the deaths today?

In view of the excellent Progress Report, and the complimentary report “Abuja + 12: Shaping the future of health in Africa”, we need to use this opportunity to shape the future of the AIDS response in Africa. We recommend:

Generate innovative financing solutions:
Today, most of the people on treatment are funded through the Global Fund and PEPFAR; thank you but looking into the future, this is not sustainable.
Increase domestic financing of the response consider national health insurance
Strengthen taxation – the report recently released by Kofi Annan estimates that Africa is losing up to $65 billion in taxation loopholes
Increasing private sector healthcare investment.
Foreign remittance is bigger than all the aid Africa recieves
Call on Ministers of Finance to budget for health beyond ODA; assistance is important but if people are to be on ART for 30 years, we have to budget beyond ODA

Secure Commodities needed in the AIDS response through Local Production
Today 85% of medicines come from India; we should thank India, but if they decide to pursue more lucrative chronic disease markets tomorrow, what will Africa do?
Market for pharmaceuticals projected to reach US$1,3 Trillion by 2020, but Africa’s share of that market will only be US$7 Billion.
Need to really step up local production of drugs and commodities; South Africa, for example, is producing its own drugs and the quality is better than drugs from India and less expensive than India as well.
Way to this is to consolidate markets in the sub-regions of the continent, promote hubs of manufacturing excellence where each country buys shares, rather than each country manufacturing for its small market
Local production creates employment, saves foreign currency, encourages entrepreneurship and positions Africa in the new knowledge economy.
Need for drug regulatory harmonization including quality control, medicines registration and licensing, and drug formulary listing.

Human Resources for Health
Strengthen Africa’s human health resources including training more health workers and training them better. Example from Ethiopia which has trained and is using more than 35 000 Community Health Workers.
Combine this with use of technology; example of one of the states in Nigeria which is using mobile phones to track patients and improve adherence, and send the information in real-time for referrals.
Need for innovative service delivery to include diagnostics and delivery of medicines.

Integration
We need People-Centred Accountability; it does not make sense to treat a person of HIV but let them die of TB.
Move from focus on disease to focus on people: mortality from Cervical Cancer higher than birth-related deaths. HIV positive people have 6-7 times risk of HPV which leads to cervical cancer
Focusing on people allows us to consider all HIV-related diseases including cervical cancer, TB, hepatitis, and even non-communicable diseases
Focusing on people is the sure way to achieve integration between HIV/SRH/TB and general health and development.
Leave no one behind. Include everyone, especially the most vulnerable, Strengthen social protection and human rights, Enforce the laws that safeguard rights, and End gender inequality and gender-based violence especially for girls and young women.

It is not acceptable that 90% of the AIDS deaths are in Africa. African leaders have to keep AIDS at the centre of the Post-2015 and call for ending AIDS by 2030. African leaders have to Call for ending the AIDS epidemic (in Africa) by 2030 by ensuring zero (preventable) AIDS deaths, and zero new HIV infections among young women and zero sexual violence.