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Posts Tagged ‘Global Health Council’

For the last few months, those advocating for a more robust fight against AIDS have been growing increasingly concerned about the stagnant funding levels from the President’s Emergency Fund for AIDS Relief and the Global Fund to Fight AIDS, Tuberculosis and Malaria.

But what about the years ahead? What’s the epidemic going to look like in 20 years, how much funding will be needed, and how are the choices today going to impact on the epidemic in the years to come?

To get a glimpse at future scenarios, Robert Hecht, managing director at Results for Development Institute, a two-year-old group of development experts based in Washington, D.C., will launch a report, “Costs and Choices,’’ on Monday at the Global Health Council conference in Washington, D.C. The report was done under the auspices of aids2031, a group of AIDS specialists headed by Peter Piot, former executive director of UNAIDS, and Stefano Bertozzi, the HIV director for the Bill & Melinda Gates Foundation’s Global Health Program.

Hecht will present a range of findings from the group’s research, including this surprising statistic: Some 50 percent of the Global Fund’s AIDS funding now goes to middle-income countries, as does roughly 20 percent of PEPFAR’s funding. Hecht has advocated in the past that middle-income countries start to assume the bulk of that cost, and that donors, including PEPFAR, should shift those funds to countries truly in need.

Monday’s session – 2-3 p.m in the Palladian Ballroom at the Omni Shoreham Hotel – also will feature Paul Bouey, deputy global AIDS coordinator, and Rifat Atun, director for Strategy, Performance and Evaluation Cluster at the Global Fund. Also giving an on-the-ground perspective will be David Apuuli, director general of the Uganda AIDS Commission,and Benson Chirwa, director general of the National AIDS Council in Zambia.

It should shed some light not only on the future needs in funding AIDS, but also give a glimpse into policymakers’ thinking in how they can meet those needs. We will be posting after Monday’s session.

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This post is by the Global Center’s Rabita Aziz

Musa Bugundu, the UNAIDS country coordinator for Uganda, spoke with global HIV/AIDS advocates yesterday at an event sponsored by the Global Health Council about the current HIV situation in Uganda, making several suggestions about the best ways to move forward.

Bugundu spoke at length about successes in the fight against HIV thanks to political leadership and commitment and funding from PEPFAR and other sources. However, he stressed that much more needs to be done, as there are hundreds of thousands of HIV infected individuals who have no access to treatment. Bugundu warned that with the recent flatlining of funding and the proposal of harmful legislation in Uganda like the Anti-Homosexuality Bill, the progresses made against the epidemic may be reversed.

At the peak of the AID crisis in Uganda in 1992, HIV prevalence was 18 percent among adults. This number has now stabilized to 6.4 percent. At present, over 350,000 persons are in need of care, with just over half of the infected population receiving treatment. Twenty two percent of HIV infected pregnant women are transmitting the disease to their newborns, and the prevalence rate among children is .7 percent.

Bugundu stressed that reducing mother-to-child transmission rates is a critical component of the HIV response because vertical transmission can easily be prevented given that the right resources are present. In addition to applying resources to such concrete endeavors, Bugundu stressed that attitudes toward women and children must be changed. There should be a renewed focus on treating women and young girls more equitably, he said, and the well-being and development of young girls should be a priority. He said it is deplorable that people do not see any negative impacts of the practice of child marriage and consequently, child pregnancy. He said the culture must be changed so women and girls are not like treated like second-class citizens, which places them at a higher risk for contracting HIV.

Bugundu went on to say that “a combination of culture and religion makes things difficult.” He said that the messages sent to young people to abstain from sex and to be faithful are ineffectual, and that people need to face reality of the numbers: 43 percent of new infections occur in monogamous, heterosexual couples. This is one reason why the Anti-Homosexuality Bill, proposed by MP David Bahati last October, is so appalling, he said. In 2008, less than 1 percent of new infections occurred in same-sex couples.

In 2007, Parliament had criminalized homosexuality. The new bill goes further and aims to prosecute not only HIV infected individuals who transmitted the disease, but also to punish individuals who fail to report another person’s homosexual orientation to authorities. This would mean that doctors, religious leaders, teachers, and others must turn in a gay or lesbian person, or face three years in jail.

Bugundu said if adopted this provision would have a very negative impact on the HIV situation in Uganda, as those infected with HIV would stop seeking help for fear of being imprisoned, which in turn would result in more people becoming infected.  Bugundu credited pressure from the international community as playing a key role now in watering down the scope of the bill.

But he said the entire bill must be removed as a way to deal with the HIV situation. In addition, there must be renewed commitment from political leaders, who must take more ownership of the HIV response, he said.

Along with more financial support, African leaders should be held more accountable by donors for their actions.  In addition, he said, there should be more integration of services as the fragmentation of services has proven to be detrimental.

He gave several suggestions on the best ways ahead, including the scale up of male circumcision, the scale up of ARV treatment, and more efforts put towards reducing stigma and discrimination against those who are infected.

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There were plenty of frightening statistics and unsettling trends highlighted at today’s World TB Day briefing on Capitol Hill. But one photo captured the true scope of the problem in scaling up diagnosis and treatment of the global TB epidemic.

Celine Gounder, MD, an IDSA member and TB/HIV specialist at Johns Hopkins University, described a recent trip to Malawi, where she saw shopkeepers volunteering to collect sputum samples from customers with chronic coughs. The accompanying photo: a man transporting the sputum samples to a laboratory in a small wooden box balanced on the back of his bicycle.

Dr. Celine Gounder discusses the TB epidemic at a Senate briefing

As Dr. Gounder noted, this small community had overcome one of the hurdles in getting suspected TB patients access to proper care. But many others remain. For starters, those specimens so carefully balanced on the bike would be examined using sputum smear microscopy, the only widely available diagnostic test for TB in Malawi. But Malawi has one of the highest HIV prevalence rates in the world, and the vast majority of HIV-related TB cases will be missed by sputum smear microscopy. A more accurate TB test, culture, is not available in the country because of lack of funding. So many of the patients will get false negative results, and continue to transmit the TB bug.

Her presentation provided compelling evidence of the need for more resources devoted to increased laboratory capacity and better diagnostics for TB. But she noted the gap between rhetoric and reality when it comes to TB funding. See Dr. Gounder’s power point here: CGounder_US Senate Briefing_20100324 and below is a video of her presentation.

“Despite the clear need for a heightened response to the global TB problem, funding that has been appropriated for these activities falls short of what was authorized by the Lantos-Hyde Act and what is needed to make decisive progress,” she said. “USAID, which is the primary US agency conducting global TB activities, received only $225 million in FY 2010 of the $650 million dollars authorized.”

She noted in particular that the White House’s Global Health Initiative includes TB treatment targets that are much lower than those set out in the Lantos-Hyde Act, which reauthorized PEPFAR. And she said HIV/TB co-infection was getting particularly short-shrift.

“Little more than lip service has been paid to delivery of TB-related interventions by HIV programs,” Gounder said.  “Only 16% of all TB patients were tested for HIV in 2007. Only 2.2% of HIV patients were screened for TB. And only 30,000 of HIV patients, 2% of the target, received isoniazid preventive therapy, which has been proven to reduce the risk of TB and mortality by one-third to two-thirds.”

Gounder’s remarks came at a Senate briefing on the global TB epidemic, which included a special focus on drug-resistant TB. The event, entitled “Bringing Methods to Scale: New Perspectives in the Changing World of TB,” also featured a presentation by Ernesto Jaramillo, team leader for MDR-TB for the World Health Organization’s Stop TB Department, who detailed the WHO’s newest data on drug-resistant TB. (more…)

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Many details of the Obama Administration’s Global Health Initiative are still murky, and it’s unclear just when we will learn more. In the meantime, the Global Health Council has launched a little Internet information hub about the GHI, with relevant documents, media coverage, and other related info. It’s at least a good starting point to sort out what we know, and what we don’t, about the six-year $63 billion plan. Check it out here.  You can also get another perspective on the GHI–and how it should be framed and funded–here.

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President Obama’s US Global AIDS Coordinator, Eric Goobsy, MD, discusses health system strengthening, PEPFAR’s tight budget, the Administration’s Global Health Initiative, and other subjects in this interview posted on the Global Health Council’s blog. It’s definitely worth reading for the latest insights into the Administration’s plans for battling global AIDS.

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From antiretroviral drugs to bicycles, one program in Zambia is redefining the notion of integrated health services and care.

The Global Health Council’s Vince Blaser blogged about the program, called RAPIDS, or Reaching HIV and AIDS Affected People with Integrated Development and Support, here.

The program’s main focus in HIV prevention and treatment, but implementers have added a range of additional services–from malaria prevention to food security. And then there are the bikes–offered to caregivers to help them “cover greater distances, use it for personal or economic reasons and transport community members to local clinics,” as Blaser writes. 

This seems like just the kind of innovative program information we’re looking for as we gather hard data and interesting anedcotes about the impact of PEPFAR and other global AIDS programs on developing country health systems for a special report on this topic.  Please feel free to share any similar info or stories!

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The Group of 8 Summit has not gotten underway yet (the official kick-off is tomorrow), but we already have a little bit of global health-related news, via to David Olson, the Global Health Council’s Director of Policy Communications.

Olson is liveblogging here from the G8 meeting and in his first post, he reports that a delegation from the Global Call to Action Against Poverty, an umbrella group of NGOs, managed to get a personal meeting with Italian Prime Minister Berlusconi at which they delivered a letter outlining key demands on global health. The letter calls on the G8 leaders to:

• Fully fund the Global Fund to Fight HIV-AIDS, TB and Malaria;

• Align the G-8’s aid for health with the developing country governments’ health strategies;

• Act upon the Kampala Declaration to reach the target of 4.1 health workers per 1,000, thus hiring the 4.25 million health workers needed immediately;

• To deliver, as agreed at the G-8 in Heiligendamm in 2007 and reaffirmed in Tokyo in 2008, $60 billion by 2011 to fight pandemics as well as $1.5 billion to improve maternal, newborn and child health and scale up this support for an additional $10.2 billion per year.

Olson writes that Prime Minister Berlusconi offered to circulate this letter to the other seven heads of state at the upcoming summit.

In addition to Olson’s live blogging, another group of poverty and health advocates has organized a central site for bloggers and others to pull together relevant analysis and resources from the G8 meeting. Check it out and add your two cents!

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