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By Muku Mugwagwa

Last week , the keynote speaker at the opening plenary of the 2010 International AIDS Conference in Vienna, Austria,  was former President Bill Clinton. He took charge of the stage to address how to move forward in the global fight against AIDS. HIV & AIDS has become a chronic disease – we must transition our efforts from an emergency response to one we can sustain.

Clinton began his speech on an optimistic note, stating that the fight against AIDS has managed to raise more funding than any other epidemic in the world. In particular, Clinton highlighted the efforts of UNITAID as an effective avenue for stimulating broad based private funding. Small donations from campaigns such as Project Red prove that small donations from a large mass of people can go a long way in the fight against 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.

With sometimes impenetrable terrain and limited infrastructure, Yemen presents a very challenging environment for delivering health services to rural areas. Basic health services do not reach most women; rural areas lack health facilities; and Yemen’s conservative cultures do not allow women to receive health services from men, or to freely come and go from their home.

In Yemen, through a pilot program, the Extending Service Delivery (ESD) Project supported the Basic Health Services (BHS) Project to assist midwives with setting up private practices in rural communities where facilities did not exist or were too far away. Midwives are generally respected in Yemen communities and, most husbands allow their wives to visit the midwives in their homes.

At the Global Health Council Conference, I attended an interesting event, “Impact of Schistosomiasis and Polyparasitic Infections on Anemia, Growth and Physical Fitness in Children in Coastal Kenya” presented by  Dr. Amaya Bustinduy of Case Western Reserve University which focused on neglected tropical diseases (NTD).

Schistosomiasis remains one of the most serious and prevalent neglected tropical diseases worldwide.  According to Bustinduy, the WHO estimated that there are 235 million cases of schistosomiasis with 732 million to be at risk for contraction. 89% of  all cases live in the less-developed areas of rural sub-Saharan Africa and South America.

Schistosomiasis is associated with diseases such as anemia, growth impairment in children, and mental retardation.  The focus of Dr. Bustinduy’s ongoing study in Kenya is to “address those morbidities as part of a larger study examining the ecology of transmission of Schistosomiasis.”

The Group of Eight (G-8), holding their annual summit last weekend in Muskoka,Canada, announced a Canadian-led Muskoka Initiative on Maternal, Newborn and Under-Five Child Health (Muskoka Initiative). The Group of 20 (G-20) summit held immediately after in Toronto, resulted in no additional commitments to maternal and child health. MSH believes the G-20 missed an opportunity to support global health when the group did not endorse the G-8’s maternal and child health initiative announced the day before. The G-20 is a group of key finance ministers and central bank governors that meets semi-annually on matters relating to the international financial system.

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