HIV & AIDS

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.

MSH is attending the Social Welfare Workforce Strengthening Conference in Cape Town this week. AIDSTAR-Two, a USAID-funded MSH led project, is a key organizer of the conference.

Ghazal Keshavarzian, Better Care Network Senior Coordinator, provides an update from the Social Welfare Workforce Strengthening Conference in Cape Town, South Africa. This post originally appeared on OVCsupportnet.org.

Over 150 government, academic, and civil society representatives from across Africa, Vietnam, Haiti and the United States are gathering this week in Cape Town, South Africa to share lessons learned and plans for future efforts to strengthen the social welfare workforce that cares for vulnerable children and families. Funded by USAID and PEPFAR, the Social Welfare Workforce Strengthening Conference is raising the profile of this very important but neglected issue.

Last year, the mHealth Alliance and the National Institute of Health (NIH) sponsored their first mobile health (mHealth) “Summit,” at the Ronald Reagan building in Washington, DC. The location was telling: it is the home of the US Agency for International Development (USAID). This year’s mHealth Summit has nearly doubled in size, moved its location to the Convention Center, and is being keynoted by Bill Gates and Ted Turner. It is safe to say that mHealth is certainly a topic de jour. The problem is that the big names---the global mobile phone network providers, manufacturers, pharma companies, and global consulting firms---are all jumping on the bandwagon, but they are late to the game. And the conversations in the plenary sessions highlight the fact that there’s a huge disconnect between the global companies and the on-the-ground implementers.

Blog post also appeared on Global Health Magazine.

PEPFAR Fellow in the field

As the country with the second highest maternal mortality rate in the world, outranked only by India, Nigeria loses one in every 18 women during child-birth. The country also has one of the highest infant mortality rates in the world, one of the lowest life expectancy rates---estimated at 47 years---and the second largest population of people living with HIV & AIDS, with only 30% of people eligible for anti-retroviral treatment able to access these life-saving drugs.

A team of experts from WHO, UNICEF, UNFPA, and World Bank recently published a report on maternal mortality entitled “Trends in Maternal Mortality: 1990 to 2008" (PDF).

The document reports some fantastic news about a public health indicator that has until recently refused to budge. That indicator is the maternal mortality ratio, the number of maternal deaths per 100,000 live births. The improvement between 1990 and 2008 is significant and promising.

The part of the report that received much less coverage relates to HIV and its strong, adverse effect on maternal mortality. The authors estimate that in 2008 there were 42,000 deaths due to HIV & AIDS among pregnant women and approximately half of those were maternal deaths. In absence of HIV we would have had 337,000 maternal deaths in 2008 instead of 358,000.

Blog post originally appeared on Global Health Magazine.

Six years ago the Malawi health system was on the verge of collapse due to severe shortages of health workers. Every year the College of Medicine would train 20 doctors and every year, half of them would leave the country. Nurses were overwhelmed by the demand for services.

In mid-June the United States Government continued to show its commitment to global health by announcing the first Global Health Initiative (GHI) Plus countries: Bangladesh, Ethiopia, Guatemala, Kenya, Malawi, Mali, Nepal, and Rwanda. The GHI is a six-year, $63 billion initiative to help partner countries improve measurable health outcomes by strengthening health systems and building upon proven results. The GHI focuses on women, newborns, and children using an integrated approach including programs that address HIV & AIDS, malaria, tuberculosis, maternal and child health, nutrition, family planning and reproductive health, and neglected tropical diseases. These initial countries will receive additional technical and management resources to quickly implement GHI’s approach.  They will be used as “learning labs” – using best practices and lessons learned when implementing programs in other countries. MSH works in seven of the eight countries, so we asked our country experts: What’s working? Please stay tuned for a continuing series.

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