July 2011

July 06, 2011

Thirty Years of HIV Programming: What’s Next? [2]

Jonathan D. Quick, MD, MPH [3]

Thirty years ago, we learned of a disease that began with a few cases and quickly transformed into an epidemic the world had not seen before. We were not exactly sure what it was, how it was spread, or how to care for people who had it. HIV & AIDS has had a dramatic impact on the world – and especially on people in low and middle income countries. Over the past 30 years, AIDS programming responses have changed due to developments in public health science, politics, economics, and organizational capacity.

As we look through the past thirty years, there have been three distinct generations of AIDS responses and programming. [5] In the 1980s, what we refer to as the Zero Generation, there was no effective response. Little was known and little was done about HIV & AIDS. Prevention was rudimentary, treatment nonexistent, and funding limited.

By 1990, the epidemic was already showing signs of spiraling out of control. The First-Generation programs were characterized by limited funding, a focus on prevention, continued denial in many parts of the world, and—as before— essentially no treatment in low- and middle-income countries.

South Sudan Independence: For Health It Means A Lot [7]

Management Sciences for Health [8]

Fragile States [9]

Sudan Health Transformation Project II (SHTP-II) Chief of Party John Rumunu comments on what independence means for health in South Sudan. SHTP-II is led Management Sciences for Health and funded by USAID.

“This is South Sudan” [11]

Erin Polich [12]

Fragile States [9]

One of many billboards erected in Juba, South Sudan, in anticipation of Independence day on July 9th, 2011 (Erin Polich/MSH)

MSH, leader of the the USAID-funded Sudan Health Transformation Project- II, is proud to congratulate South Sudan on their independence. The following blog post discusses the impact that independence will have on South Sudan’s health system and the challenges that still lie ahead.

South Sudan Independence: July 9, 2011 (Photos) [14]

Management Sciences for Health [8]

HIV & AIDS [4]

South Sudan Independence: July 9, 2011 (Photos)

Independence Celebrations: Juba, South Sudan [16]

Management Sciences for Health [8]

Fragile States [9]

Jamila’s Triumph over HIV and Poverty in Guyana [18]

M Persaud [19]

HIV & AIDS [4]

In 2006, Jamila, a 24 year old Guyanese waitress, took the opportunity to work in a store overseas with the hope of building a better life for her children. But her dreams were dashed when she arrived in the new country and realized the only job available was as a commercial sex worker. She had no money, nowhere to stay, and no one to turn to, so she became a sex worker to survive. Jamila eventually earned enough to pay for her airfare back to Guyana, where she had left her children with her grandmother.

After her return to Guyana, she was encouraged by a friend to take an HIV test, but though the test was positive, Jamila did not believe it, as she was healthy at the time.

Jamila sought employment at a local logging company as a plywood grader. However, the challenges of her job eventually took a toll on her health and she repeatedly became ill. She thought her illness was a result of the hard work and sought alternative employment. She eventually found work as a caregiver at Guyana Responsible Parenthood Association (GRPA), one of the organizations supported by the USAID-funded, Management Sciences for Health-led, Guyana HIV/AIDS Reduction Program (GHARP II).

Simple, Low-Cost Interventions Save Babies’ Lives [21]

I Rockson [22]

Women & Gender [23]

Safoura Amadu is the 19 year-old mother of Ibrahim, who was born preterm on March 8, 2011 at 1.46 kg (3.2 pounds). Baby Ibrahim did not grow well in his first days of life. Safoura was very worried---her first child had died at birth---and she did not want to lose Ibrahim, her second child. Safoura sought help and when Ibrahim was ten days old she and the baby were admitted to the new Kangaroo Mother Care (KMC) center at the Maternité Issakha Gazoby in Niger. Ibrahim’s weight had dropped to 1.07 kg (2.35 pounds).

The KMC center cared for Safoura and her child by showing Safoura how to take two simple, lifesaving measures: provide skin-to-skin contact for Ibrahim, by wrapping his unclothed body directly to her bare chest, and breastfeeding him exclusively. After 47 days at the KMC Centre, Safoura and two month-old Ibrahim were released to go home. Ibrahim weighed 2.12 kgs (4.67 pounds).

Erik Schouten on New Approaches to Prevention of Mother to Child Transmission in The Lancet [25]

HIV & AIDS [4]

Women & Gender [23]

I’d like to call attention to an important set of articles in the recent HIV/AIDS themed issue of The Lancet [26]. Erik Schouten of Malawi Basic Support for Institutionalizing Child Survival [27] (BASICS) has published a commentary [28] (free registration required) about Malawi’s push to be the first country to implement a “B+” approach to reducing mother to child transmission.

IAS 2011: Studies Prove Treatment Really is Prevention [30]

HIV & AIDS [4]

Monday at the International AIDS Society conference in Rome [31], an expanded session featured information on the HPTN 052 study, the Partners PrEP Study, and the Centers for Disease Control’s TDF2 study presented in a joint session titled Treatment Is Prevention: The Proof Is Here, on Monday. The results of these trials will fundamentally change the way we think about HIV prevention and treatment, although implementation of these approaches will likely prove as challenging as ever.

HPTN 052, sponsored by the HIV Prevention Trials Network, was the first randomized clinical trial to definitively indicate that an HIV-infected individual can reduce sexual transmission of HIV to an uninfected partner by beginning antiretroviral therapy sooner. The study involved 1,763 HIV-serodiscordant couples at 13 sites across Africa, Asia, and the Americas. The trial results were initially released in May 2011 on the recommendation of an independent data and safety monitoring board (DSMB) and Monday’s session was the first full presentation of the trial data.

HIV Positive with Hope [33]

C Msukwa [34]

HIV & AIDS [4]

Grace Bonongwe is a grandparent. She comes from Zovuta Village T/A Nsamala in Balaka, about 10 kilometers from the nearest health facility. Of the nine children she has given birth to, only one lives to this day. The rest have died over the years from different diseases.

Grace is no stranger to disease and affliction considering she has gone through the pain of losing eight of her children. So when her husband fell ill, she dismissed it as a normal occurrence that would eventually lead to his demise. But he did not die, instead, his illness recurred on and off for a prolonged time.

Read more [33]

Links
[1] https://www.msh.org/blog/2011/07/06/thirty-years-of-hiv-programming-what%E2%80%99s-next#comments
[2] https://www.msh.org/blog/2011/07/06/thirty-years-of-hiv-programming-what%E2%80%99s-next
[3] https://www.msh.org/users/jonathan-d-quick-md-mph
[4] https://www.msh.org/blog-categories/hiv-aids
[5] http://www.msh.org/resource-center/publications/reversing-the-aids-epidemic-through-third-generation-health-systems.cfm
[6] https://www.msh.org/blog/2011/07/08/south-sudan-independence-for-health-it-means-a-lot#comments
[7] https://www.msh.org/blog/2011/07/08/south-sudan-independence-for-health-it-means-a-lot
[8] https://www.msh.org/users/management-sciences-for-health
[9] https://www.msh.org/blog-categories/fragile-states
[10] https://www.msh.org/blog/2011/07/08/%E2%80%9Cthis-is-south-sudan%E2%80%9D#comments
[11] https://www.msh.org/blog/2011/07/08/%E2%80%9Cthis-is-south-sudan%E2%80%9D
[12] https://www.msh.org/users/erin-polich
[13] https://www.msh.org/blog/2011/07/10/south-sudan-independence-july-9-2011-photos#comments
[14] https://www.msh.org/blog/2011/07/10/south-sudan-independence-july-9-2011-photos
[15] https://www.msh.org/blog/2011/07/10/independence-celebrations-juba-south-sudan#comments
[16] https://www.msh.org/blog/2011/07/10/independence-celebrations-juba-south-sudan
[17] https://www.msh.org/blog/2011/07/12/jamila%E2%80%99s-triumph-over-hiv-and-poverty-in-guyana#comments
[18] https://www.msh.org/blog/2011/07/12/jamila%E2%80%99s-triumph-over-hiv-and-poverty-in-guyana
[19] https://www.msh.org/users/mpersaud
[20] https://www.msh.org/blog/2011/07/13/simple-low-cost-interventions-save-babies%E2%80%99-lives#comments
[21] https://www.msh.org/blog/2011/07/13/simple-low-cost-interventions-save-babies%E2%80%99-lives
[22] https://www.msh.org/users/irockson
[23] https://www.msh.org/blog-categories/women-gender
[24] https://www.msh.org/blog/2011/07/19/erik-schouten-on-new-approaches-to-prevention-of-mother-to-child-transmission-in-the#comments
[25] https://www.msh.org/blog/2011/07/19/erik-schouten-on-new-approaches-to-prevention-of-mother-to-child-transmission-in-the
[26] http://www.thelancet.com/themed-hiv-aids-2011
[27] http://www.basics.org/about_basics/countries/malawi.htm
[28] http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(10)62303-3/fulltext
[29] https://www.msh.org/blog/2011/07/20/ias-2011-studies-prove-treatment-really-is-prevention#comments
[30] https://www.msh.org/blog/2011/07/20/ias-2011-studies-prove-treatment-really-is-prevention
[31] http://www.ias2011.org/
[32] https://www.msh.org/blog/2011/07/22/hiv-positive-with-hope#comments
[33] https://www.msh.org/blog/2011/07/22/hiv-positive-with-hope
[34] https://www.msh.org/users/cmsukwa