HIV & AIDS

MSH CEO, Jonathan Quick, MD, MPH moderates panel on AIDS, Human Rights, and Vulnerable Populations (Ben Greenberg/MSH)

Human rights are no longer considered peripheral to the AIDS response. Human rights are an essential tool of public health. 80% of countries explicitly acknowledge or address human rights in their national AIDS strategies. However, 80 countries still have punitive laws against people with HIV which pose significant challenges to the AIDS response

In the past decade, there have been some major developments in the HIV epidemic. New cases have decreased, 5 million people are now on treatment, and people are discussing the importance of human rights in relation to the disease. However, 33 million people are infected and only one-third of those in need of treatment are receiving it.

Prior to January 12, 2010, Management Sciences for Health’s Leadership, Management and Sustainability Program was working with Haiti’s Ministry of Public Health and Population to build capacity in several areas:  family planning and reproductive health; commodity management and security; coordinating HIV & AIDS awareness and community mobilization activities; and leadership development.

But after the terrible earthquake of one year ago, we who normally promote leadership in the health sector were faced with our own leadership challenges:  how to continue to lead and manage our program effectively during an ongoing crisis, and most importantly, how to ensure continued help to those who rely on LMS support. Our immediate priority:  dealing with the collapse and destruction of our office.  For months, we worked out of large tent constructed next to the LMS warehouse, a reminder everyday that many of those we were serving had been forced to move into temporary shelters.  

This blog post originally appeared on K4Health's blog.

The most important item in Amon Chimphepo’s medical kit is a small cell phone. This single piece of technology has proved to be a lifeline for people living in one of the most remote regions of Malawi. Its power to reach and initiate help immediately from the closest hospital is saving lives and improving health outcomes. In fact, I met a woman, alive today, because Mr. Chimphepo and his cell phone were there to make an emergency call to the district hospital and get an ambulance.

At the First Global Symposium on Health Systems Research in Montreux, Switzerland in November, Dr. Yogesh Rajkotia, of USAID Rwanda, moderated a panel discussion noting that Performance-Based Financing (PBF) is an effective health systems strengthening strategy. The presentations were made on behalf of the Rwandan Ministry of Health with the guidance of Dr. Agnes Binagwaho, Permanent Secretary.

In 2000, Rwanda’s health system was perceived as weak: there were human resources shortages, especially in rural areas; poor quality of services; and a high morbidity/mortality rate of women and children. Since 2001, Rwanda has committed itself to better health and to pushing for achievement of the Millennium Development Goals (MDG) by 2015.

PBF is a powerful means for increasing the quantity and quality of health services by providing incentives to health providers to improve performance. A PBF program typically includes performance-based grants or contracts. Health clinics and their staff are rewarded for reaching or exceeding health indicators.

Annie Likhutu, shown right, receiving volunteer HIV counseling and testing services from Word Alive’s HTC volunteer, Charles Sapala.

Three months ago, Annie Likhutu, a mother of six, came to Migowi Health Center in Phalombe, Malawi to receive voluntary HIV counseling and testing (VCT); now, she is back at the health center and ready to be tested for a second time.“It is very important to know your status, it is no good waiting until you get sick,” she said.

Annie initially learned of the importance of testing through a radio advertisement from Word Alive Ministries International (WAMI), which is aired regularly and encourages listeners to go to health centers for VCT.

Although Annie takes pride in knowing her status and encourages others in her village to do so, her husband refuses to go for testing. This motivates Annie to continue returning to confirm her negative status.

There have been a collection of high-profile and well attended mobile health (mHealth) “summits” held around the world in the past few years, including last month’s second annual mHealth Summit in Washington, D.C. (headlined by Bill Gates and Ted Turner), but the really interesting conversations are happening on the African continent. While large providers in the “developed world” are talking about the need for business plans and analysis, the debate in Kenya and Nigeria and Ghana is on how country-based leadership can scale up proven programs, develop sustainability, and provide practical and integrated models for cooperation between the government, mobile service providers, the medical community and the private sector.

"It's not over yet." World AIDS Day 2010 at MSH in Cambridge, MA.

Today, MSH teams around the world  observed World AIDS Day by participating in national commemorations and offering HIV testing, counseling, and prevention messages.

On this World AIDS Day, we reflect yet again on progress made toward global commitments to fight the HIV epidemic. According to UNAIDS, new infections have decreased this past year from 2.7 million to 2.6 million, but, 30 years into the epidemic, only 5.2 million people out of the estimated 15 million who need drugs have access to treatment. Stigma, discrimination and human rights violations against persons living with HIV still exist, even in countries with generalized epidemics.

Integrated HIV programming across the entire health system can minimize many of these barriers to HIV prevention, care and, treatment.

Over 33 million people are currently living with HIV & AIDS throughout the world. Despite great strides in slowing the epidemic, there remains a stunning gap in prevention, care, and treatment efforts. This is especially true for most-at-risk-populations, which include commercial sex workers (CSWs) and their clients, injecting drug users (IDUs), men who have sex with men (MSM), and prisoners. People in these risk groups are so stigmatized and discriminated against in many countries that it becomes extremely difficult – sometimes impossible – to provide them with much-needed HIV prevention, care and treatment services. Even more, MARP behaviors often are illegal, which then compromises needed action and support from government authorities.

Denial of such basic human rights as access to prevention, care, and treatment for the most-at-risk-populations is unacceptable. It leaves those most in need underserved and severely marginalized. As World AIDS Day 2010 approaches with this year’s message of “Universal access and human rights,” I am reflecting on the specialized HIV interventions that MSH helps provide to most-at-risk populations.

The results from the first Pre-exposure Prophylaxis (PrEP) clinical trial, the iPrEx Study, were just made public and published in today’s issue of the New England Journal of Medicine. In short, the trial showed an overall 44% efficacy in preventing HIV infection in gay, bisexual and transgender subjects who took the daily fixed dose combination antiretroviral pill Truvada (tenofovir [TDF] and emtracitabine [FTC]), compared with participants receiving a placebo. This is the first evidence that oral antiretroviral medications, taken by HIV-negative people before exposure to HIV can reduce the risk of HIV infection. iPrEx is also the first trial showing effectiveness of a new biomedical prevention tool in gay men and other men who have sex with men.

The iPrEx trial enrolled 2,499 participants across 11 sites in six countries---Brazil, Ecuador, Peru, South Africa, Thailand and the United States. It is the first PrEP effectiveness trial to report results. This trial was one of a suite of PrEP trials currently ongoing in a range of populations around the world.

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