This week’s Lancet returns the spotlight to Option B+, an innovative strategy for preventing mother-to-child transmission of HIV which was first developed in Malawi with technical assistance from MSH. Four letters respond to the concern that international organizations have too quickly endorsed the Option B+ approach of providing lifelong triple antiretroviral therapy (ART), irrespective of CD4 count, to pregnant women with HIV in high-burden countries.

MSH experts Scott Kellerman, Jonathan Jay and Jonathan Quick argue that “a strong case exists for expanding research on Option B+, but not for impeding countries that pursue it on the basis of available evidence and programmatic experience:”

{Photo credit: MSH/South Africa.}Photo credit: MSH/South Africa.

Cross-posted from SHARE: Southern Africa HIV/AIDS Regional Exchange. (SHARE is an initiative of the USAID Southern Africa Regional HIV/AIDS Program with support from the Knowledge for Health project and the Southern Africa HIV and AIDS Information Dissemination Service.)

Dr. Quick discusses Myanmar’s health system with Dr. Pe Thet Khin, the minister of health. {Photo credit: Myanmar Ministry of Health.}Photo credit: Myanmar Ministry of Health.

In Myanmar, 50 years of military dictatorship left behind a seriously underdeveloped health system, serving barely one in twenty of the country’s 60 million people. You might expect that the first minister of health under civilian rule would be despondent. But on my recent trip I found the opposite: Dr. Pe Thet Khin and his team are aligned around an ambitious vision for building a strong health system for the country.

Shelly with her latest trophy after winning first place at a 2012 regional Emancipation Day race. {Photo credit: V. Hinds/MSH.}Photo credit: V. Hinds/MSH.

Shelly has always been very athletic. She competed in both her high school track events and in community races in her hometown of Essequibo, Guyana. In 2010, she was ecstatic after winning a cash prize for placing first in an annual regional championship. However, her life took a turn one year later.

Shelly became pregnant and, during an antenatal care appointment, tested positive for HIV. The news devastated her, as she believed that an HIV diagnosis meant her athletic career was over. Shelly was unaware of how to remain healthy while living with HIV, and so she soon became ill, weak, and lost a significant amount of weight. To add to this, she was unemployed and lacked the means to provide for her newborn son.

MSH: Saving lives and improving health in 2013.{Image credit: MSH.}Image credit: MSH.

We have seen some remarkable gains in global health in 2012. Yet millions of women, children, and men still die from preventable causes. As we pause and reflect on 2012 and look ahead to the new year, I invite you to read and share some of our favorite blog posts from the year.

2012 World AIDS Day event in Port au Prince, Haiti. From left to right: Pamela White, Ambassador of the United States to Haiti; Michel Sidibe, Executive Director of UNAIDS; Sophia Martelly, First Lady of Haiti; Florence Duperval Guillaume, Minister of Public Health and Population; and Guirlaine Raymond, Director General of the Ministry of Public Health and Population. {Photo credit: C.Gilmartin/MSH.}Photo credit: C.Gilmartin/MSH.

In recent years, Haiti has endured some of the greatest misfortunes in its history, including hurricanes, floods, the devastating 2010 earthquake, and the cholera epidemic that followed. These natural disasters and public health crises have added to the harm already caused by the country’s widespread poverty, social and political unrest, and under-resourced health system. Haiti’s fragile population is further plagued by the highest HIV prevalence in the Western Hemisphere at 1.9 percent, which translates to roughly 120,000 HIV-positive individuals and 93,000 children who have lost their parents to AIDS (UNAIDS, 2011).

Malawi mother and children {Photo credit: MSH.}Photo credit: MSH.

I got a call from the resident doctor to come to exam room 6. As soon as I entered the room, I prepared myself. The little girl, 7- or maybe 8-years-old, didn't look well; she was “floppy,” combative, and not entirely aware of where she was or what we were doing to her. She was HIV-positive, and my colleague needed to get an IV line in her arm to test the latest in experimental treatments for kids with HIV– and needed the four of us interns to help hold her still.

It was 1993 during my residency in pediatrics in Cleveland, Ohio. We were at one of the best children’s hospitals in the world; it didn’t matter. The young girl died a few months later.

With the advent of antiretroviral therapy (ART) a few years later, the whole world changed. The world of HIV medicine blossomed; new drugs and drug combinations literally exploded with amazing effect. HIV-positive mothers could give birth to HIV-negative babies, and HIV-positive children and their moms could get treatment.

Michel Sidibé, Executive Director of UNAIDS, discusses the new UNAIDS World AIDS Day report: Results at a press conference today in Geneva.




Trying to cross through a flooded section of road in South Sudan. {Photo credit: E. Polich/MSH.}Photo credit: E. Polich/MSH.

“We’re going to try to drive through that?”

After spending nearly two years working in South Sudan, I was on my way with two colleagues to one final meeting. The USAID-funded second phase of the Sudan Health Transformation Project (SHTP II), led by Management Sciences for Health (MSH), ended activities on July 31, 2012, and three of us needed to travel 360 kilometers (220 miles) to a results dissemination meeting. A flight booking mishap meant we had no choice but to drive --- during rainy season.

With a key bridge washed out.

And it rained --- down poured --- for over an hour the morning we left.

After passing several toppled trucks, overtaking pickups irrevocably mired in mud, and crossing through a river, we came across the point where I uttered the above quote (“We’re going to try to drive through that?”).

Democratic Republic of the Congo {Photo credit: MSH.}Photo credit: MSH.

Last night, while in the Democratic Republic of the Congo (DRC) visiting our programs, I attended a US election-eve gathering of mostly Congolese people in Kinshasa. The DRC is one of those “distant nations” President Obama was referring to in his early morning acceptance speech today, where people are, “risking their lives just for… the chance to cast their ballots like we did today.”

Fragile, conflict-ridden nations, such as the DRC, struggle with leadership and governance. Its people have been victims of horrific violence, stunning gender inequality, and some of the worst health conditions in the world. They deserve better.

The United States reelected President Barack Obama to lead not only our country, but also to lead on addressing global health and other global development challenges such as those faced by the DRC.

Management Sciences for Health (MSH), a global non-profit organization dedicated to saving lives and improving health for the poorest and most vulnerable in the world, has long been a partner with the US government, foundations, and other donors, working in more than 140 countries to build stronger and more sustainable health care systems.


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