Transforming Our World: Implementing the 2030 Agenda Through Sustainable Development Goal Indicators.

The United Nations' 2030 Agenda for Sustainable Development recognizes violence as a threat to sustainability. To serve as a context, we provide an overview of the Sustainable Development Goals as they relate to violence prevention by including a summary of key documents informing violence prevention efforts by the World Health Organization (WHO) and Violence Prevention Alliance (VPA) partners. After consultation with the United Nations (UN) Inter-Agency Expert Group on Sustainable Development Goal Indicators (IAEG-SDG), we select specific targets and indicators, featuring them in a summary table. Using the diverse expertise of the authors, we assign attributes that characterize the focus and nature of these indicators. We hope that this will serve as a preliminary framework for understanding these accountability metrics. We include a brief analysis of the target indicators and how they relate to promising practices in violence prevention.

Prevalence of sexual violence against children and use of social services - seven countries, 2007-2013.

Sexual violence against children erodes the strong foundation that children require for leading healthy and productive lives. Globally, studies show that exposure to violence during childhood can increase vulnerability to a broad range of mental and physical health problems, ranging from depression and unwanted pregnancy to cardiovascular disease, diabetes, and sexually transmitted diseases, including human immunodeficiency virus (HIV). Despite this, in many countries, the extent of sexual violence against children is unknown; estimates are needed to stimulate prevention and response efforts and to monitor progress. Consequently, CDC, as a member of the global public-private partnership known as Together for Girls, collaborated with Cambodia, Haiti, Kenya, Malawi, Swaziland, Tanzania, and Zimbabwe to conduct national household surveys of children and youth aged 13-24 years to measure the extent of violence against children. The lifetime prevalence of experiencing any form of sexual violence in childhood ranged from 4.4% among females in Cambodia to 37.6% among females in Swaziland, with prevalence in most countries greater than 25.0%. In most countries surveyed, the proportion of victims that received services, including health and child protective services, was ≤10.0%. Both prevention and response strategies for sexual violence are needed.

Preventing sexual violence and HIV in children.

BACKGROUND: Evidence linking violence against women and HIV has grown, including on the cycle of violence and the links between violence against children and women. To create an effective response to the HIV epidemic, it is key to prevent sexual violence against children and intimate partner violence (IPV) against adolescent girls. METHODS: Authors analyzed data from national household surveys on violence against children undertaken by governments in Swaziland, Tanzania, Kenya, and Zimbabwe, with support of the Together for Girls initiative, as well as an analysis of evidence on effective programmes. RESULTS: Data show that sexual and physical violence in childhood are linked to negative health outcomes, including increased sexual risk taking (eg, inconsistent condom use and increased number of sexual partners), and that girls begin experiencing IPV (emotional, physical, and sexual) during adolescence. Evidence on effective programmes addressing childhood sexual violence is growing. Key interventions focus on increasing knowledge among children and caregivers by addressing attitudes and practices around violence, including dating relationships. Programmes also seek to build awareness of services available for children who experience violence. DISCUSSION: Findings include incorporating attention to children into HIV and violence programmes directed to adults; increased coordination and leveraging of resources between these programmes; test transferability of programmes in low- and middle-income countries; and invest in data collection and robust evaluations of interventions to prevent sexual violence and IPV among children. CONCLUSIONS: This article contributes to a growing body of evidence on the prevention of sexual violence and HIV in children.

Lessons from the President's Emergency Plan for AIDS Relief: from quick ramp-up to the role of strategic partnership.

In its first five years, the President's Emergency Plan for AIDS Relief (PEPFAR)--the largest commitment ever by any nation to combat a single disease--succeeded in getting 2.1 million people on antiretroviral treatment and 10.1 million people in care; prevented an estimated 237,600 HIV infections in infants; and saved an estimated 3.28 million adult years of life. Much of the global program's success can be attributed to early decisions to implement new structures and approaches designed to meet its ambitious targets quickly, overcome bureaucratic inertia, and ensure continued progress. A unified US government program was created with a single coordinator. There was a focus on quick ramp-up, strategic partnerships, and sustainable local ownership. Accountability and performance were emphasized. These new approaches played critical roles in translating the unprecedented resources and political support for PEPFAR into improved health for millions of people. Successful aspects of the way in which PEPFAR was organized and implemented, along with less successful or deficient ones, offer lessons for any large, complex international health initiative.

Use of generic antiretroviral agents and cost savings in PEPFAR treatment programs.

CONTEXT: One of the biggest hurdles to the rapid scale-up of antiretroviral therapy in the developing world was the price of antiretroviral drugs (ARVs). Modification of an existing US Food and Drug Administration (FDA) process to expedite review and approval of generic ARVs quickly resulted in a large number of FDA-tentatively approved ARVs available for use by the US President's Emergency Plan for AIDS Relief (PEPFAR). OBJECTIVE: To evaluate the uptake of generic ARVs among PEPFAR-supported programs in Guyana, Haiti, Vietnam, and 13 countries in Africa, and changes over time in ARV use and costs. DESIGN, SETTING, AND PARTICIPANTS: An annual survey from 2005 to 2008 of ARVs purchased in 16 countries by PEPFAR implementing and procurement partners (organizations using PEPFAR funding to purchase ARVs). MAIN OUTCOME MEASURES: Drug expenditures, ARV types and volumes (assessed per pack, a 1-month supply), proportion of generic procurement across years and countries, and cost savings from generic procurement. RESULTS: ARV expenditures increased from $116.8 million (2005) to $202.2 million (2008); and procurement increased from 6.2 million to 22.1 million monthly packs. The proportion spent on generic ARVs increased from 9.17% (95% confidence interval [CI], 9.17%-9.18%) in 2005 to 76.41% (95% CI, 76.41%-76.42%) in 2008 (P < .001), and the proportion of generic packs procured increased from 14.8% (95% CI, 14.79%-14.84%) in 2005 to 89.33% (95% CI, 89.32%-89.34%) in 2008 (P < .001). In 2008, there were 8 PEPFAR programs that procured at least 90.0% of ARV packs in generic form; South Africa had the lowest generic procurement (24.7%; 95% CI, 24.6%-24.8%). Procurement of generic fixed-dose combinations increased from 33.3% (95% CI, 33.24%-33.43%) in 2005 to 42.73% (95% CI, 42.71%-42.75%) in 2008. Estimated yearly savings generated through generic ARV use were $8,108,444 in 2005, $24,940,014 in 2006, $75,645,816 in 2007, and $214,648,982 in 2008, a total estimated savings of $323,343,256. CONCLUSION: Among PEPFAR-supported programs in 16 countries, availability of generic ARVs was associated with increased ARV procurement and substantial estimated cost savings.