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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.
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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 [email protected] 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 the countries.
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 technical knowledge; 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 of HIV: 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 Development Goals.
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.
affected families.
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: By
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: By
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: By putting
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: By promoting
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 Cross-cutting strategies 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- accountability frameworks; 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.
Measuring progress, 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 Orphans supported * 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. estimated needs. 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 at www.unaids.org 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

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