HIV & AIDS

Monday at the International AIDS Society conference in Rome, an expanded session featured information on the HPTN 052 study, the Partners PrEP Study, and the Centers for Disease Control’s TDF2 study presented in a joint session titled Treatment Is Prevention: The Proof Is Here, on Monday. The results of these trials will fundamentally change the way we think about HIV prevention and treatment, although implementation of these approaches will likely prove as challenging as ever.

HPTN 052, sponsored by the HIV Prevention Trials Network, was the first randomized clinical trial to definitively indicate that an HIV-infected individual can reduce sexual transmission of HIV to an uninfected partner by beginning antiretroviral therapy sooner. The study involved 1,763 HIV-serodiscordant couples at 13 sites across Africa, Asia, and the Americas. The trial results were initially released in May 2011 on the recommendation of an independent data and safety monitoring board (DSMB) and Monday’s session was the first full presentation of the trial data.

I’d like to call attention to an important set of articles in the recent HIV/AIDS themed issue of The Lancet. Erik Schouten of Malawi Basic Support for Institutionalizing Child Survival (BASICS) has published a commentary (free registration required) about Malawi’s push to be the first country to implement a “B+” approach to reducing mother to child transmission.

In 2006, Jamila, a 24 year old Guyanese waitress, took the opportunity to work in a store overseas with the hope of building a better life for her children. But her dreams were dashed when she arrived in the new country and realized the only job available was as a commercial sex worker. She had no money, nowhere to stay, and no one to turn to, so she became a sex worker to survive.  Jamila eventually earned enough to pay for her airfare back to Guyana, where she had left her children with her grandmother.

After her return to Guyana, she was encouraged by a friend to take an HIV test, but though the test was positive, Jamila did not believe it, as she was healthy at the time.

Jamila sought employment at a local logging company as a plywood grader. However, the challenges of her job eventually took a toll on her health and she repeatedly became ill. She thought her illness was a result of the hard work and sought alternative employment. She eventually found work as a caregiver at Guyana Responsible Parenthood Association (GRPA), one of the organizations supported by the USAID-funded, Management Sciences for Health-led, Guyana HIV/AIDS Reduction Program (GHARP II).

Thirty years ago, we learned of a disease that began with a few cases and quickly transformed into an epidemic the world had not seen before. We were not exactly sure what it was, how it was spread, or how to care for people who had it. HIV & AIDS has had a dramatic impact on the world – and especially on people in low and middle income countries. Over the past 30 years, AIDS programming responses have changed due to developments in public health science, politics, economics, and organizational capacity.

As we look through the past thirty years, there have been three distinct generations of AIDS responses and programming. In the 1980s, what we refer to as the Zero Generation, there was no effective response. Little was known and little was done about HIV & AIDS. Prevention was rudimentary, treatment nonexistent, and funding limited.

By 1990, the epidemic was already showing signs of spiraling out of control. The First-Generation programs were characterized by limited funding, a focus on prevention, continued denial in many parts of the world, and—as before— essentially no treatment in low- and middle-income countries.

The theme of this year’s Global Health Council annual conference was Securing a Healthier Future in a Changing World. As populations are shifting, so are their health priorities. Increasing urbanization has led to more people living in and around cities, creating a series of problems that are new to public health professionals. Nutritional challenges, the need for improved water and sanitation infrastructure, and addressing the issue of unregulated health care providers are all problems facing governments, ministries, NGOs, donors, and populations. In addition, non-communicable diseases (NCDs), including cancer, diabetes, cardiovascular conditions, and mental illness, are adding a new strain to many already resource constrained health systems. Of course, immunization, malaria, pneumonia, diarrhea, and maternal death are all still very serious challenges in many of these systems and remain key priorities.

Yesterday the results of HIV Prevention Trials Network (HPTN) 052, a clinical trial funded by the National Institutes for Health, offered definitive proof of what we have long suspected---that treating HIV infected persons substantially reduces the risk of transmitting HIV to uninfected persons.

This is FANTASTIC news and offers very convincing evidence that, at least for heterosexual discordant couples (the study was not able to enroll significant numbers of gay men), if the infected person is on ART, the uninfected partner is protected. And more broadly, it offers significant evidence that treatment is indeed highly effective in preventing transmission of HIV. This can reasonably be described as a “game changer” with respect to how we think about HIV prevention, care, and treatment. We used to talk about “treatment as prevention,” but now we can say “treatment IS prevention.”

Read the UNAIDS report here.

Cynthia Isioma, Nigeria

In the village of Owa Ofie, Nigeria, Cynthia Isioma, a young girl who has survived enormous odds reclaimed her dream of secondary education.

Cynthia lost both parents at the age of two and was left in the care of her grandmother who died three years later. Cynthia’s situation grew more challenging when she was then moved to her blind grandfather’s home at the age of five.

Rather than receive care, Cynthia had to take on the responsibility of caring for her grandfather who could not afford to send her to school.  Cynthia became a child caregiver, providing for herself and her grandpa. Her daily duties included going to the forest to collect cocoyam, palm nuts, snails, and waterleaves to sell and for household use.

Cynthia’s situation changed when she was 13 years old and Rural Linkage Network (RULIN), a community-based organization based in Boji Boji, visited Owa Ofie to identify orphans in need of support. RULIN is supported by the USAID-funded, MSH-led Community Support for OVC Project (CUBS).

This blog post originally appeared on the US Agency for International Development's IMPACT blog.

Yodit Assefa (center) and procurement colleagues from PEPFAR’s Supply Chain Management System (SCMS). Photo credit: SCMS

As a procurement specialist with PEPFAR’s SCMS (the Supply Chain Management System) project, I am one of a growing number of women working in supply chain management in Ethiopia. I manage procurements of HIV/AIDS commodities---including the complex procurement of specialized medical equipment used to treat HIV/AIDS---as well as the vehicles that distribute those commodities.

Well planned, strategic procurement is a smart investment. Our team helps save money by minimizing costly unplanned and emergency procurements and buying low-value and bulky products locally.

It’s common sense that a mother who is on treatment for AIDS, pregnant, has a sick child, and is accompanying a sister debilitated by Tuberculosis should not have to visit four separate service delivery points to receive care. Integrated health services not only make the world a healthier place, but also decrease the burden on health systems.

Integration is a comprehensive approach to service delivery. It is the transition from a vertical or horizontal approach to a diagonal, synergistic approach at all levels of a health system. Smart integration means coordinating disease specific programs (such as HIV and AIDS) with other health programs that have operated independently in the past (for example, family planning) to deliver services at the same time or, more importantly, with the same funding. Integration helps organizations maximize the impact of their health investments while allowing people, information, and funding to flow more easily among collaborating groups and stakeholders. Equally important, integration enables providers to treat the health needs of individuals and families more efficiently---regardless of the initial reason a person seeks care.

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