HIV & AIDS

The Global Health Initiative (GHI) and its approach of integrating health programs with HIV & AIDS, malaria, tuberculosis, maternal, newborn, and child health, nutrition, and family planning and reproductive health is in line with the current approaches and health priorities of the Government of Malawi.

Malawi, with a population of slightly over 13 million people, has 83% of its people living in the rural hard to reach, underserved areas. The biggest health challenge facing the country is access to basic health services by the rural population. The problem of access to health services is multifaceted. For instance, family planning services are mostly facility-based, contributing to a low Contraceptive Prevalence Rate of 28% and high unmet family planning need of 28% (Malawi Demographic and Health Survey, 2004).

However, there is also a critical shortage of trained health service providers and availability of contraceptives is a logistical nightmare in Malawi. Making a routine mix of all contraceptives accessible to women of reproductive age regularly in rural communities can avert unwanted pregnancies and maternal deaths, and reduce high total fertility rate and infant mortality rate. Rural people walk long distances to seek health services, sometimes only to return without a service due to shortage of health personnel and stock-out of supplies.

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.

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.

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.

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.

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