HIV & AIDS

At the International AIDS Conference in Vienna, Austria, my colleagues and I gathered to discuss the principles of smart integration and its challenges, successes, and recommendations for implementation. 

Smart integration means coordinating HIV & AIDS programs with other health programs that have operated independently in the past; providing comprehensive services at all levels of the health system – from households to health facilities and across the continuum of prevention, treatment, and care; and building stronger partnerships between public and private sectors.

There are three perspectives of integration that must be kept in mind when discussing integration – the client, provider, and the efficiency. Smart integration is important now because AIDS has become a chronic disease and we need to move away from the emergency response interventions.

On July 19, here in Vienna at the XVIIIth International AIDS Conference, positive results were announced from the CAPRISA 004 Phase IIb microbicide trial of 1% tenofovir gel, which was tested in 889 South African women. Overall, there were 39 percent fewer infections among women who received the gel compared to women who received the placebo –and the results showed 51% efficacy of the gel against transmission of herpes simplex virusto women.  Of note, recent vaccine trials and microbicide trials have set as a limit of efficacy 30% in order to be considered “effective”, which generally means that the FDA will approve them.  

The South African Minister of Health, Dr. Aaron Motsoaledi, provided a clear picture of a new era of HIV & AIDS care, treatment, and prevention in South Africa at the International AIDS Conference on Tuesday morning.

All of South Africa is united behind one goal of fighting HIV & AIDS,  he said.  Dr. Motsoaledi stands behind a firm commitment to human rights, “access to care, treatment, and prevention is a human right.”

He is working with the Government of South Africa to ensure universal access in their country. “Human rights are not a threat to democracy, but a sign of good governance,” he said.

29% of South Africa’s population has HIV & AIDS, “The new infection rate seems to have stabilized, but this number is extraordinarily high, and unacceptable,” said Dr. Motsoaledi

The Government’s national strategy plan has two targets to reach by the end of 2011. First, to reduce the number of new infections by half; and second, to provide care and support to 85% of those effected by HIV & AIDS.

This past April, the Government of South Africa started a testing campaign; the goal is to test 15 million South Africans. The leaders of the national government paved the way for the movement by getting tested first.

As we have heard, Haiti is the poorest country in Western Hemisphere and has some of the worst health statistics. Many things did not work well before the earthquake and the recovery effort has not progressed as many had hoped.

There is a perception among some, though, that nothing was working before the January 12th earthquake and that nothing has happened since.

Certainly in the health sector, and specifically in AIDS, this perception is simply wrong. The earthquake has been devastating for Haiti and its people, but in the health sector there were many good things going on before the earthquake and some real strengths to build upon. The government of Haiti, at both the national and department level, has been playing a strong leadership role.

MSH first began working in Haiti over 30 years ago. Over the last decade our nearly all-Haitian staff has worked intensively to develop leadership, management, planning, and service delivery skills within the Ministry of Health and Population, nationally and at the departmental and local levels. We also work to strengthen over two dozen service delivery NGOs.

Originally appeared in GLOBAL HEALTH magazine.

Men who have sex with men (MSM) bear a disproportionate share of the HIV/AIDS burden in Eastern Europe and Central Asia, but data on and services for this population are woefully inadequate. With a better understanding of this marginalized community's needs, donors and implementers can help support effective policies and programs for MSM infected and affected by HIV.

In Eastern Europe and Central Asia, as in many parts of the world, the HIV epidemic among MSM is underreported and under”acknowledged. The lack of official reports on HIV among men who have sex with men might enable governments to avoid prioritizing or even offering interventions, and HIV programmers can fail to reach those most in need.

Without the data and analysis of MSM issues it is easy for governments and HIV/AIDS programmers to not develop MSM programs and interventions as: (a) no data means it can look like MSM is not a problem and therefore not a priority and (b) lack of recognition of the issue means that it is easy for governments'/programmers' own homophobia to get in the way of developing programming.

Next month in Vienna, Austria, thousands of activists, community workers, donors, health leaders, and government officials will gather for the VVIII International AIDS Conference.  This year’s theme is Rights here, right now: a mandate on the importance of health as a human right for all.  While it is easy to talk about health as a human right, it is much more difficult to deliver to diverse communities in some of the poorest countries around the world. 

Last year when President Obama announced his Global Health Initiative (GHI), he spoke about meeting the health needs of the world by leveraging current resources and integrating programs for greater health impact. Integrating HIV & AIDS services with other health services such as reproductive health (including family planning), TB, malaria, or maternal and child health increases effectiveness and ultimately sustainability. 

On Friday, June 18th  USAID Administrator, Dr. Rajiv Shah spoke at the National Press Club in Washington, DC about the role USAID must play in the future of development. “President Obama and Secretary Clinton have made it my mission to remake USAID into the world’s premier development agency, to meet the security and development needs of the 21st Century,” said Dr. Shah.  In his presentation he laid out four elements for action to revitalize USAID

Just over five months ago, Haiti suffered a devastating earthquake that displaced more than 700,000 people.  Addressing the health needs of such a large population in a post-disaster situation is a complex challenge, one Management Sciences for Health (MSH) is supporting through its many programs including our Leadership, Management and Sustainability Program (LMS).

UNAIDS’s new campaign aims to eliminate mother to child transmission (MTCT) of HIV by the 2012 World Cup in Brazil. It is fantastic to see that UNAIDS is using the enthusiasm and media coverage of World Cup to draw attention to one of Africa’s most pressing health issues, perinatal transmission of HIV.

My colleague Jude Nwokikie, program manager of the Strengthening Pharmaceutical Systems (SPS) project in South Africa and Namibia declared, “The world is no longer in the mood to tolerate MTCT.”

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