Joint action for results: unaids outcome framework 2009–201
Joint Action for ResultsUNAIDS Outcome Framework2009–2011
UNAIDS/09.13E – JC1713E (English original, May 2009)
Updated version March 2010
Joint United Nations Programme on HIV/AIDS (UNAIDS) 2010.
All rights reserved. Publications produced by UNAIDS can be obtained from the UNAIDS Content Management Team. Requests for permission to reproduce or translate UNAIDS publications—whether for sale or for noncommercial distribution—should also be addressed to the Content Management Team at the address below, or by fax, at +41 22 791 4835, or e-mail: [email protected]
The designations employed and the presentation of the material in this publication do not imply the expression of any opinion whatsoever on the part of UNAIDS concerning the legal status of any country, territory, city or area or of its authorities, or concerning the delimitation of its frontiers or boundaries.
The mention of specific companies or of certain manufacturers' products does not imply that they are endorsed or recommended by UNAIDS in preference to others of a similar nature that are not mentioned. Errors and omissions excepted, the names of proprietary products are distinguished by initial capital letters.
All reasonable precautions have been taken by UNAIDS to verify the information contained in this publication. However, the published material is being distributed without warranty of any kind, either expressed or implied. The responsibility for the interpretation and use of the material lies with the reader. In no event shall UNAIDS be liable for damages arising from its use.
Cover photo: UNAIDS
WHO Library Cataloguing-in-Publication Data
Joint action for results: UNAIDS outcome framework, 2009–2011.
"UNAIDS/09.13E / JC1713E".
1.HIV infections – prevention and control. 2.HIV infections – epidemiology. 3.Technical cooperation.
4.Interinstitutional relations. I.UNAIDS.
ISBN 978 92 9173 780 2
(NLM classification: WC 503.6)
T (+41) 22 791 36 66
F (+41) 22 791 48 35
CH-1211 Geneva 27
Joint Action for ResultsUNAIDS Outcome Framework, 2009–2011
"People forget. We are here to act. We are here to deliver results. We are agents of change. Our job is to change the UN – and,
Photo UNAIDS / P. Virot
through it, the world."
Secretary-General Ban Ki-moon
Photo UNAIDS / P. Virot
Photo UNAIDS / P. Virot
Photo UNAIDS / P. Virot
Photo UNAIDS / P. Virot
The global response to the HIV epidemic
Secretariat of the United Nations System
is at a crossroads. The emergency footing of
Chief Executives Board for Coordination,
the response over the past 25 years and the
the crisis will affect all countries, with a
broad social mobilization of stakeholders
serious and disproportionate impact on the
have spearheaded remarkable action and
poorest, and could leave 80% of the world's
results. Yet the hard-won gains are fragile and population without a social safety net.
call for a renewed commitment and leader-ship by the United Nations system. Our
The HIV organizational landscape has
joint efforts have produced encouraging
evolved and grown more complex over
results, but many challenges lie ahead.
the past decade. UNAIDS, donors and civil society, including networks of people living
In order to achieve further progress, it is
with HIV, have rightly demanded greater
essential to take steps to address specific gaps
clarity on the relationships between needs,
in the response to the epidemic as well as
financing, activities and outcomes. Also
the social, political and structural constraints
demanded is greater specificity about the
that limit results.
role of UNAIDS and the Secretariat within
Progress requires that the UNAIDS
the wider constellation of actors.
Secretariat, the Cosponsors1 and other
We are responding through this Outcome
partners protect and build on the gains
Framework to optimize our partnerships
already made and make use of the
between the UNAIDS Secretariat and the
opportunities for linking specific actions
Cosponsors. The Outcome Framework,
and broader agendas for reaching the
which builds upon the UNAIDS Strategic
Millennium Development Goals.
Framework (2007–2011), will guide future
The challenges facing the response to
investment. It will also hold the Secretariat
AIDS are exacerbated by the current global
and the Cosponsors accountable for making
financial and economic crisis. As stated
the resources of the UN work for results in
in the April 2009 communiqué from the
1 The ten UNAIDS cosponsoring organizations are: Office of the United Nations High Commissioner for Refugees (UNHCR), United
Nations Children's Fund (UNICEF), World Food Programme (WFP), United Nations Development Programme (UNDP), United Nations Population Fund (UNFPA), United Nations Office on Drugs and Crime (UNODC), International Labour Organization (ILO), United Nations Educational, Scientific and Cultural Organization (UNESCO), World Health Organization (WHO), World Bank.
Keeping the momentum
In 2006, the world made a historic commit-
action can make a difference. Flexibility in
ment at the United Nations aimed at the
planning and budgeting is critical, as is the
goal of universal access to comprehensive
ability to monitor progress and results.
prevention programmes, treatment, care
We will continue to strive for increased effi-
and support. The achievement of universal
ciency and effectiveness in the response to
access will remain the fundamental priority
AIDS, and to demonstrate the added value
for UNAIDS. Universal access goals can
of coherence in the UN system and its
become a reality. By achieving these goals,
collective impact at the country level.
we can contribute to the broader develop-ment agenda.
We will revive the unified forces of the Cosponsors and the implementation of
The multisectoral determinants of the
a relevant UN response to the epidemic.
epidemic demand dynamic and multifaceted
Delivering results in priority areas holds the
responses that must constantly evolve to
Cosponsors and the UNAIDS Secretariat
meet emerging challenges and priorities. We
accountable in each area of their respective
have identified areas in which our collective
Photo UNAIDS / J. Wainwright
Under the Outcome Framework for the
Union and the Association of Southeast Asian
period 2009–2011, UNAIDS will continue
Nations, and coalitions such as Health 8.
to advocate for comprehensive national responses, including ramped-up prevention
Substantial progress on a number of the
efforts to break the trajectory of the epidemic, Millennium Development Goals can be and will refocus its efforts on achieving results achieved by taking the AIDS response out in ten priority areas. These priority areas
of isolation and integrating it with efforts
have been selected because their realization
to achieve broader human development
will contribute directly to the achievement
and the goals of health and social justice.
This Outcome Framework affirms the UNAIDS Secretariat and
Cosponsors to leverage our respective organizational mandates and resources
to work col ectively to deliver results.
of universal access and will simultaneously
The response to AIDS should be about
enable advancement towards the related
building bridges and restoring trust in
Millennium Development Goal outcomes.
Our success demands a shift in the develop-
Future investments in the AIDS response will
ment agenda, in which poverty reduction is
accompanied by a growth in dignity, freedom
The commitment to stand by people
and equality. In this model of develop-
living with and affected by HIV;
ment, women and men — including those
Measurable impacts on preventing new
pushed to the margins of society — will have
infections and on the people most
enhanced control over their lives.
The AIDS movement has used the power
The promotion of human rights and
of human rights to transform society's
approach to the epidemic. The global
The best available scientific evidence and
movement of people living with HIV and
the nearly four million people on treatment
Comprehensive responses to AIDS that
are a force for change.
integrate HIV prevention, treatment, care and support;
UNAIDS will fully engage partners and
The pursuit of wider results in terms of
stakeholders from all sectors, including civil
developmental outcomes; and
society, networks of people living with HIV,
Programme coherence and alignment of
the private sector, governments, regional
external resources to national priorities
intergovernmental groups such as the African
to effectively deliver results.
Ten priority areas and cross-cutting strategies
Under the Outcome Framework for the
We can reduce sexual transmission
period 2009–2011, UNAIDS will focus its
Sexual transmission accounts for
efforts on achieving results in ten priority
more than 80% of new HIV infections
areas. These priority areas have been selected
worldwide. Reversing the global AIDS
based on a series of consultations with the
epidemic requires a dramatic increase in
Cosponsors, communities, civil society and a
community, national and global action for
broad range of other stakeholders.
sexual and reproductive health and rights,
The realization of these priority areas will
and in individual commitment to safer
accelerate the achievement of universal
sex. We can reduce sexual transmission
access. It will require effort and commitment
of HIV by promoting social norms and
from all stakeholders, and can bring about
individual behaviours that result in sexual
even greater results in terms of wider
health; by supporting the leadership of
developmental outcomes and contribute
people living with HIV for ‘positive
to the attainment of the Millennium
health, dignity and prevention'; and
by supporting universal access to key prevention commodities and services,
In our continuous efforts to support all
especially for the most vulnerable.
countries to halt and reverse the epidemic, address its drivers and mount an effective
We can prevent mothers from
response, major relevant strategies for
dying and babies from becoming
combination HIV prevention must be
infected with HIV:
By scaling up
strengthened, brought to scale and extended
access to and the use of quality services
to meet the particular needs of all those
for the prevention of mother-to-child
at risk, including people on the move and
transmission (+) as an integral part of
people in emergency settings.
sexual and reproductive health services
The priority areas are interlinked, and
and reproductive rights for women, their
hence progress in one area will contribute
partners and young people. This includes
to progress in others. In many cases, a single
ongoing care and treatment for women,
programmatic activity can promote action in
and their partners, and children in
more than one of the priority areas.
HIV prevention key to changing the trajectory of the AIDS epidemic
For every two people who start on HIV treatment, five are newly infected. UNAIDS must magnify its focus on HIV prevention while addressing the specific needs of each key population, including youth, women and girls, sex workers and their clients, injecting drug users, men who have sex with men, prisoners, refugees and migrants. This will help change the course of the epidemic.
UNAIDS advocates for a combination approach to HIV prevention that is tailored to local epidemics. Combination prevention requires action simultaneously both on the immediate risks and on the underlying drivers of the epidemic.
Combination HIV prevention involves choosing the right mix of HIV prevention actions and tactics to suit the unique epidemic in each country and matching the needs of those most at risk, just as the right combination of drugs and nutritional support is chosen for antiretroviral treatment.
Combination HIV prevention means providing services and programmes for individuals, such as promoting the knowledge and skills necessary to undertake safe behaviours. These include knowledge of HIV status, knowledge of risks, reducing concurrent and serial sexual partners, using condoms consistently, scaling-up male circumcision and the prevention of mother-to-child transmission services. Combination HIV prevention needs investment in structural interventions, including legal reforms to outlaw discrimination against people living with HIV and the enforcement of laws that prohibit sexual and gender-based violence. It also requires the promotion of a desire for behaviour change while simultaneously acting to shift community norms and broader social environments. Only in this way can HIV prevention responses be widespread and sustainable. Combination prevention highlights the synergies that can come when these programmes are coordinated and reinforce each other.
There is no single ‘magic bullet' for HIV prevention, but by making the right choices every country's HIV prevention efforts can have the power, relevance and scale required to stop new HIV infections.
We can ensure that people living with
ensuring an effective integrated delivery of
HIV receive treatment:
By scaling up
services for HIV and tuberculosis as well as
and sustaining treatment coverage and
nutritional support in all settings.
bridging the gap between sexual and reproductive health and HIV, integrating
We can protect drug users from
nutritional support within treatment
becoming infected with HIV:
programmes and increasing the number of
making comprehensive, evidence-informed
skilled and equipped health workers.
and human-rights-based interventions accessible to all drug users (i.e. harm
We can prevent people living with
reduction and demand reduction), including
HIV from dying of tuberculosis:
programmes to reduce hepatitis coinfection,
and by ensuring that legal and policy
positive change to the lives of women
frameworks serve HIV prevention efforts.
and girls and by utilizing opportunities to comprehensively respond to sexual and
We can empower men who have
sex with men, sex workers and
transgender people to protect
We can empower young people to
themselves from HIV infection and
protect themselves from HIV:
to fully access antiretroviral therapy:
young people's leadership at the centre of
by ensuring that men who have sex with
national responses, providing rights-based
men, sex workers and transgender people
sexual and reproductive health education and
are empowered to both access and deliver
services and empowering young people to
comprehensive and appropriate packages
prevent sexual and other transmission of HIV
of HIV prevention, treatment, care and
infection among their peers. By ensuring
support services and by ensuring that law
access to HIV testing and prevention efforts
enforcement agencies and the judicial
with and for young people in the context
system protect their rights. Currently, access
of sexuality education. And by ensuring
to prevention, treatment, care and support
enabling legal environments, education
services is limited compared with the share
and employment opportunities to reduce
of the burden faced by these populations.
vulnerability to HIV.
We can remove punitive laws, policies,
We can enhance social protection for
practices, stigma and discrimination
people affected by HIV:
that block effective responses to AIDS:
the provision of a range of social services
By collaborating with civil society and all
to protect vulnerable populations,
stakeholders to uphold non-discrimination
including populations of humanitarian
in all efforts, countering social judgement
concern, refugees, internally displaced
and the fear that feeds stigma, delivering on
persons and migrants, informal-economy
the broader human rights agenda, including
workers, people experiencing hunger, poor
in the areas of sex work, travel restrictions,
nutrition and food insecurity and orphaned
homophobia and criminalization of HIV
and vulnerable children. By promoting
transmission, ensuring access to justice and use of the law by promoting property and
corporate social responsibility, workplace
inheritance rights, protecting access to and
policies and income generation for
the retention of employment and protecting
people affected by HIV. By empowering
marginalized groups and reinforcing the
governments, particularly ministries of
work of UN Plus.
labour, employers and workers to adopt, implement and monitor HIV-related
We can meet the HIV needs of
policies. And by countering discrimination
women and girls and can stop
and promoting HIV prevention, treatment,
sexual and gender-based violence:
care and support through workplaces,
by building on the synergies between
including through UN Cares, and their
the gender and AIDS response for
links with the community.
Photo UNAIDS / P. Virot
These outcome areas call for joint action. In
Improve country-by-country strategic
order to address these areas effectively, the
information generation, analysis and use,
Secretariat and the Cosponsors will support
including through the mobilization of
cross-cutting strategies and institutional delivery
mechanisms that build on what we know works and will take steps for change where we need
Assess and realign the management of
to work differently and work better. We will:
technical assistance programmes;
Bring AIDS planning and action into
Develop shared messages for sustained
national development policy and broader
political commitment, leadership develop-
ment and advocacy; and
Optimize UN support for applications to,
Broaden and strengthen engagement with
and programme implementation of, the
communities, civil society and networks
Global Fund to Fight AIDS, Tuberculosis
of people living with HIV at all levels of
Translating priority areas into measurable
The ultimate impacts of the renewed
financial resources where they can make
commitment to universal access reflected in
the most difference to the epidemic. Joint
the Outcome Framework will be averting
programmes of support will be scaled up
HIV infections and HIV-related deaths and
substantially and will become the norm and
improving the quality of life of people living not the exception.
with HIV. This is in line with the sixth
UNAIDS country staff will increasingly
Millennium Development Goal, to halt and
focus their efforts on:
reverse the AIDS epidemic.
Brokering and unifying the management
For each of the ten priority areas, as well
of relevant technical support for appro-
as the cross-cutting strategies, specific
priate national AIDS responses;
outcomes and targets will be established in the UNAIDS Unified Budget and Workplan
Producing strategic analyses of program-
matic quality to improve results-based implementation;
The UBW brings together the individual and joint efforts of the ten Cosponsors
Enabling political agents to demand
and the UNAIDS Secretariat to opera-
change in governance, legislation and
tionalize the Outcome Framework. The
policy to support evidence-informed
specific results and corresponding budgets
of the Cosponsors and the Secretariat will be defined. Clear accountability indicators
Developing oversight structures to
will be developed and used to track prog-
ensure mutual accountability to demand
ress and to monitor the achievement of the
outcomes and the action agenda.
Supporting the Cosponsors, in order to
In supporting the implementation of the
maximize their comparative advantage at
Outcome Framework, UNAIDS will
the country level in support of national
increasingly concentrate its human and
efforts to achieve universal access.
promoting accountability, achieving the vision
Following the historic G20 summit in
increase coverage of services, ensure quality
March 2009, UN Secretary-General Ban
and ensure that services are equitable.
Ki-moon made clear the importance
If countries were to reach their 2010 targets
of turning the economic crisis into an
for universal access, a dramatic change in the
opportunity for a sustainable future. The
course of the epidemic would follow (see
UN system will actively participate in a
new vulnerability monitoring and alert mechanism to track developments and
In order to establish baselines, measure
report on the political, economic, social and
progress and monitor success or failure,
environmental dimensions of the crisis.
multiple sources of data and methodologies must be used. No single indicator can
Each of the ten priority areas represents a
capture the entire scope of progress towards
distinct goal. Each priority area requires a
any of these outcomes. We will use a mix of
strategic combination of specific actions that
relevant quantitative indicators, composite
should be tailored to the country's specific
indices and specific qualitative assessments.
epidemic and that must identify the most
We will synthesize this information into
effective strategies, build local capacity,
a meaningful understanding of whether
If countries reached their 2010 targets for universal access*, this would dramatically
change the course of the epidemic.
Expected outcomes in 132 low- and middle-income countries (in millions)
Number of new HIV infections (annual)
People on antiretroviral treatment
Workers reached in the workplace
Pregnant women offered comprehensive
prevention of mother-to-child transmission services
Men who have sex with men reached
Safe injections provided
* Under the country-defined universal access approach countries achieve different programmatic targets at different times and the achieve-
ment of universal access by al countries by 2015.
We can prevent mothers from dying and babies from becoming infected
with HIV — how to measure progress
To know if a country has achieved this priority area, we need indicators to answer questions such as:
Have the most effective multiple drug combinations for preventing HIV
transmission (according to the latest guidelines), rather than the use of just one drug (such as nevirapine), been utilized?
Were mothers evaluated for initiation of full, ongoing antiretroviral treatment?
Have other sexual and reproductive health services been provided (e.g.
congenital syphilis screening and treatment)?
Were other members of the family provided services, with siblings and spouses
being tested, counselled and started on therapy as needed?
Has counselling taken place on infant feeding and on the future use of
Has there been an exploration of the possible social support services that may be
necessary, such as for nutrition and education?
progress is truly being made and where
care workers available compared with the
bottlenecks are impeding progress.
By 2010, nearly US$ 25 billion (US$ 18.9
Each of the ten priority areas will be
billion–US$ 30.5 billion) will be needed
monitored and assessed in the same
annually for low- and middle-income
comprehensive way — outcome by
countries. To assess access to funds, countries
outcome and country by country. The
will be mapped based on the proportion
common dimensions of capacity, coverage,
of available funds from all sources (national
quality, equity and efficiency are needed
and international) compared with the
to provide the framework for assessing
estimated resource needs and the number of
the impact in each country and to enable
countries with successful HIV-related grant
comparability across countries.
applications to the Global Fund to Fight
Ultimately, we are concerned with results
AIDS, Tuberculosis and Malaria. Countries
for people, whether and why our efforts are
will also be monitored according to the
effective at achieving measurable impacts
level of investment in the strengthening of
on new infections, life expectancy and
the health sector and the number of health-
quality of life.
UNAIDS is an innovative joint venture of the United Nations, bringing together the efforts and resources
of the UNAIDS Secretariat and ten UN system organizations in the AIDS response. The Secretariat head-
quarters is in Geneva, Switzerland—with staff on the ground in more than 80 countries. The Cosponsors
include UNHCR, UNICEF, WFP, UNDP, UNFPA, UNODC, ILO, UNESCO, WHO and the World Bank.
Contributing to achieving global commitments to universal access to comprehensive interventions for HIV
prevention, treatment, care and support is the number one priority for UNAIDS. Visit the UNAIDS website
UNAIDS20 AVENUE APPIACH-1211 GENEVA 27SWITZERLAND
Tel.: (+41) 22 791 36 66Fax: (+41) 22 791 48 35e-mail: [email protected]
Uniting the world against AIDS
Capítulo 8 Intoxicación por paracetamol C. Luaces i Cubells, A. Noguera Julian El paracetamol (acetaminofén) es el analgésico-antipirético más uti- lizado en el mundo. Su fácil accesibilidad y su presencia en la mayoríade hogares, lo convierten también en la primera causa de intoxicaciónmedicamentosa (accidental y voluntaria) y de insuficiencia hepáticaaguda. Datos recientes aportados por el Grupo de Trabajo de Intoxica-ciones de la SEUP, lo sitúan como la primera causa de intoxicación far-macológica en menores de 5 años, sobre todo por ingesta de prepara-ciones líquidas sin tapones de seguridad. Así, y según comunica dichoGrupo de Trabajo, la ingesta accidental de paracetamol resultó ser el 16%del total de intoxicaciones, el 25% de las medicamentosas y el 88.5% delas intoxicaciones por antitérmicos entre un grupo de 1700 pacientes aten-didos en 18 Hospitales desde Enero de 2001 hasta Diciembre de 2002. Enuna revisión efectuada por el Servicio de Información Toxicológica entreenero de 1998 y diciembre de 2000, de 13.044 intoxicaciones registradas,el 11% estuvieron causadas por paracetamol.
Degradation and Metabolite Production of Tylosin in Anaerobic and Aerobic Swine-Manure Lagoons A. C. Kolz, T. B. Moorman, S. K. Ong, K. D. Scoggin, E. A. Douglass Watershed contamination from antibiotics is becoming Degradation half-lives for tylosin reported in the literature average a critical issue because of increased numbers of confined animal-feeding 4 to 8 days in swine, calf, and chicken manure; 2 to 8 days in aqueous