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Posts Tagged ‘PMTCT’

`A Scandal’ – Children Issues Not On Agenda

Peter McDermott is the Managing Director of the Children’s Investment Fund Foundation (CIFF), one of the largest charities in the United Kingdom. He previously had worked at UNICEF for 21 years, serving as Chief of the HIV/AIDS section in the program division at UNICEF headquarters in New York, as well as holding positions in Africa and Europe. After the Pacific Health Summit in London last week, where he laid out an ambitious agenda for advancing efforts to prevent the transmission of HIV from mother to child and to treat HIV-positive children, John Donnelly interviewed McDermott about his expectations for the International AIDS Conference in Vienna, starting July 18.

Peter McDermott, Managing Director, Children's Investment Fund Foundation

 

McDermott said he will reply to any questions posed in the Comments section and that he welcomes any suggestions for CIFF’s work in these areas.


Q: What are your goals for the AIDS conference?

A: My mind goes back to the AIDS conference where Stephen Lewis was chairing a session with Bill Clinton and Bill Gates, and one of the themes was we would address and eliminate the transmission of HIV from mother to child. That was four years ago. There’s an element of, `We’ve been here before.’ But there’s never progress in the interim. We need to be very sober about what we are trying to do, a little less self-congratulatory, and a little more self-critical.

Q: So what’s realistic? (more…)

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Last week, the Center for Strategic and International Studies (CSIS) brought together a number of panelists from various administration agencies and NGOs at an event called “Linkages between Gender, AIDS, and Development – Implications for U.S. Policy.”  Panelists discussed the importance of placing women’s and girl’s health at the forefront of the Obama Administration’s global health efforts, and how policymakers and implementers can integrate programming that has already been proven to be effective, into the new Global Health Initiative. 

Ambassador Eric Goosby, the U.S. Global AIDS Coordinator, opened up the event by stating that women and girls are disproportionately impacted by the HIV/AIDS epidemic, and focusing on women and girls when implementing programs to fight HIV/AIDS will yield positive results for not only women and girls but entire communities. 

According to Goosby, 62 percent of individuals on PEPFAR-supported treatment are women.  PEPFAR will start new women-focused programs next year, such as a new gender-based violence initiative, and the PEPFAR Gender Challenge Fund, which makes an additional $8 million available for strengthening gender-based programs.

Ambassador Goosby explained that the Obama Administration’s new Global Health Initiative will build off existing programs to ensure that the necessary linkages are made to integrate family planning, reproductive health, and HIV/AIDS services.  He explained that women and girls should have access to a ‘one-stop-shop’ for services.  In addition to making more services available, Goosby underlined the importance of engaging in diplomatic dialogue with leaders to encourage them to address discriminatory laws and practices against women.

The resounding message of the day was the importance of integrating reproductive health services, family planning services, maternal and child health services, and HIV/AIDS services all in one synergistic package to ensure that women and girls in developing countries have all the tools they need to protect their wellbeing. 

Dr. Marsden Solomon of Family Health International (FHI) in Kenya explained the necessity of integrating such services by citing that 60 percent of their HIV/AIDS patients have unmet family planning needs.  He went on to explain that integrating HIV/AIDS and family planning services reduces unintended pregnancies, prevents vertical transmission, and improves maternal and child health overall.  FHI began integrating their HIV/AIDS and family planning services in 2001.  Their services include ARV and PMTCT treatment, STI treatment, pre and post-natal care, cervical cancer screening, and post-rape care, among others.

Amie Batson, Deputy Assistant Administrator for Global Health of the USAID, argued that women’s health should be promoted not just in health-related programs, but in economic growth programs, education initiatives, and in governance as well.  Health service accessibility should be expanded as well: commodities should be available at more locations, such as at kiosks or beauty salons.

A number of panelists emphasized the importance of integrating HIV/AIDS services and prevention techniques into economic development programs as a way to address both economic and health disparities.  Lufono Muvhango and Julia Kim described their successes in battling both HIV/AIDS and economic underdevelopment with the Image Program in South Africa.  The program not only provides microfinance loans to women in villages, but also implements gender training programs which aim to empower women to have the confidence needed to fight against sexual violence. 

In South Africa, it is estimated  that a quarter of women are living in abusive relationships.  Women involved in abusive relationships are 50 percent more likely to be infected with HIV/AIDS, compared to women who do not fall victim to intimate partner violence.  After reaching out to 12,000 women in 160 villages in South Africa, the Image Program has not only seen a significant increase in HIV/AIDS awareness, but has seen a 55 percent reduction in the risk of physical and sexual violence.

Pearl-Alice Marsh, the majority professional staff member for the House Committee on Foreign Affairs, stated that there are two major issues blocking progress in women’s health and HIV/AIDS concerns.  The first is funding: Marsh stressed that advocates must continue to pressure Congress to maintain their financial commitments, as well as help African nations get a handle on their budgeting so they can contribute more to the fight against HIV/AIDS and increase their ownership.  The second issue deals with global women’s health being a proxy for anti-abortion advocacy.  Marsh explained that letting ideology and politics get in the way of women’s health amounts to femicide, and more should be done to ensure that such rhetoric does not hinder progress in global women’s health.

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This posting is by Rabita Aziz, Program Associate at the IDSA/HIVMA Global Center

The new report by the Center for Strategic and International Studies (CSIS) Commission on Smart Global Health Policy  calls for the U.S. to double contributions to better maternal and child health, to $2 billion a year.  Such investments should be focused on a few core countries in Africa and South Asia where there is a clear need, where partner governments are willingly engaged, and where concrete health gains can be made along with increasing a country’s capacities.

The report demonstrates that maternal mortality is a profound problem by offering this data: a woman’s risk of dying in pregnancy or childbirth is 1 in 7,300 in the industrialized world, 1 in 120 in Asia, and 1 in 22 in sub-Saharan Africa.  Although there are clear preventative solutions in many of these cases, accessing such measures is problematic.

The report states that improving maternal mortality requires an interlinked set of interventions that are supported and sustained over time, including heightened efforts to improve local transport.  In addition to addressing maternal mortality, it is imperative that efforts to end child and infant mortality are undertaken.  The report states that it is estimated that a package of 16 simple and cost-effective measures could prevent nearly 3 million of the estimated 4 million deaths in the first month of life.  Additionally, expanding access to immunizations can save the lives of 2 million children under the age of five.

Although the report clearly states that maintaining America’s commitment to fighting against HIV/AIDS is one element in a global health strategy, it fails to integrate this commitment within the framework of strengthening maternal and child health.

Globally, HIV/AIDS is the leading cause of death among women of reproductive age.  When half of the 31.3 million people living with HIV worldwide are women, and 98 percent of them reside in developing countries, the importance of envisioning HIV/AIDS as a maternal and child health issue is clear.  Integrating HIV/AIDS efforts within efforts to improve maternal and child health, and scaling them up, is key to a rights-based approach to health.

Among pregnant women in Johannesburg, South Africa’s most populous city, HIV is the main cause of death, according to a five-year study of maternal mortality at one of the city’s largest public hospitals

It is also important to recognize that HIV-negative children born to HIV-positive mothers still face high mortality risks as long as their mothers are not receiving treatment.   A Ugandan study found that not only is there a 95% reduction in mortality among HIV infected adults after 16 weeks of antiretroviral treatment, but there is an 81% reduction in mortality in their uninfected children younger than 10, and an estimated 93% reduction in orphan hood.[1]

Unfortunately, there is no mention in the report of undertaking initiatives to reduce the prevalence of HIV/AIDS among women and ensure access to treatment as a key maternal health strategy, even though it is clear that taking such measures will greatly strengthen families and communities.  Prevention of mother to child transmission of HIV is imperative, as well as ensuring access to ongoing treatment for the mother.


[1] Mermin et al (2008) Mortality in HIV-infected Ugandan adults receiving antiretroviral treatment and survival of their HIV-uninfected children: a prospective cohort study Lancet 371: 752-759.

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What is the best way to scale up and improve HIV treatment, care, and prevention for women and children?

The International AIDS Society tries to answer that pressing question with today’s release of a “comprehensive research agenda” focused specifically on addressing HIV knowledge gaps related to women and children. The IAS document, called “Asking the Right Questions: Advancing and HIV Research Agenda for Women and Children,” was created in coordination with more than a dozen other global health organizations.

This coalition notes that women and children make up the majority of the 33 million people living with HIV today, and yet there are many scientific barriers to proper treatment and prevention. For example, treating HIV in infants and children is very difficult because of a lack of pediatric dosages of antiretroviral drugs.

“HIV is the leading cause of death among women of reproductive age, and the leading cause of child death in many African countries, yet women and children are often either overlooked completely or folded into general responses to HIV,” IAS Executive Director Robin Gorna says in this press release touting the research agenda. “This agenda defines priority research needed to greatly improve our knowledge about and capacity to prevent and treat HIV in women and children. Implementation of this research agenda is key to closing these knowledge and service gaps, and to saving women’s and children’s lives.”

The research agenda lists four general categories as priorities:

1) Clinical research on prevention of mother-to-child transmission (PMTCT) and pediatric treatment

2) Clinical research on treatment issues for women

3) Operations research for women

4) Operations and implementation research related to PMTCT, including pediatric care, treatment and support.

Click here to read the whole document.

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This post is by Global Center Director Christine Lubinski, reporting this week from CROI in San Francisco.

Attention turned to HIV among women and children at CROI today, when Elaine Abrams, MD, a senior a professor of pediatrics and epidemiology at the Columbia University College of Physicians & Surgeons and the Mailman School of Public Health, provided an informative  overview of the challenges in protecting children from HIV in developing-world settings.  For starters, she said, we are not doing a very good job in preventing HIV infection in women, with 1 million new infections a year in women. Then there are the 1,000 new pediatric HIV infections every single day. And in most high prevalent developing world settings, there is very poor access to family planning services, leaving women with few tools to prevent unwanted pregnancies.

In the context of antiretroviral therapy scale-up, there has been a failure to identify and prioritize pregnant women for ART who are at risk of transmitting HIV infection to their infants.

There has also been limited scale-up of prevention of mother to child transmission programs, in large part because these programs are layered into the limited infrastructure available in many countries for maternal and child health services. Too often, there has been an over-reliance on short-term ART for pregnant women, rather than a continuum of care and treatment for HIV-infected women and their children.

Until recently, there was no ART intervention for prevention of post-natal transmission, leaving many infants vulnerable to HIV transmission during the breastfeeding period. Current strategies using daily neviripine in infants during breastfeeding reduces the risk of HIV acquisition, but it also confers neviripine resistance on infants who fail prophylaxis at very high levels – some 52 percent.  Drug alternatives to neviripine are not widely available.  The public health approach to ART access in developing-world settings is anchored in neviripine-based regimens.  Lopinivir is the only protease inhibitor available for infants.  In general, there are very few ART options available for children in resource-poor countries, especially in the context of widespread neviripine resistance.

Dr. Abrams also noted that there is very limited capacity for early diagnosis in infants, even though mortality in this population is extremely high.  Thirty-five percent of HIV-infected infants, if untreated, will die in their first year of life, and that number increases to 53 percent by age two.  The World Health Organization recommends that all HIV-positive children under age 1 should receive ART therapy.

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Evaristo Marowa, UNAIDS Country Coordinator for Botswana, said today that major opportunities to prevent HIV, and save billions of dollars in the long run, will be missed if the US and the international community fail to increase AIDS funding for Botswana and other countries in southern and eastern Africa. 

He made his comments in a presentation at the Global Health Council, where he also provided a powerpoint:  Botswana HIV epi and responses.  Dr. Marowa’s presentation comes as global AIDS advocates anxiously await next week’s release of President Obama’s budget proposal.  His urgent warning about the danger of donors adopting a flat or near-flat funding approach provided an interesting counterpoint to last week’s CSIS publication on HIV prevention, which did not mention the need to increase funding in its recommendations to the US government.

Dr. Marowa is a physician with a specialty in dermatology and sexually transmitted infections (STIs). He trained at Universities in Harare, Kinshasa, Liverpool and London.  Since September 2006, he has been the UNAIDS country coordinator in Botswana, and previously he worked in Tanzania, Zimbabwe, and Bangladesh.

HIV prevalence in Botswana has fallen in recent years from 38% to 24%, with declines seen particularly in young people. The country has had strong leadership on the issue at the highest levels, which Marowa called “visionary and committed.” Prevention of mother-to-child transmission has been “an astounding success,” with a transmission rate of about 4%.  A large proportion of people have been tested for HIV, about 60 to 70%, and access to antiretroviral medications is also high at about 85%.  PEPFAR has been a major support to these programs, providing about $90 million a year.

However, he said that a high degree of internal mobility in the population, multiple concurrent partnerships, low rates of male circumcision, low condom use, and high rates of gender-based violence, which form the basis for an ongoing HIV/AIDS crisis.  Marowa also cited alcohol abuse as a contributing factor, an issue on which he said the current president was very active. (more…)

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The end of today’s UNAIDS progress report, detailing the latest figures on access to ARVs, is in some ways more important than the beginning. “The Way Forward,” the report’s conclusion, lays out important next steps in the campaign for universal access, at a time when the global economic crisis and questions about sustainability have cast a cloud over global AIDS initiatives.

To be sure, today’s report, put out by UNAIDS, WHO, and UNICEF, leads with some excellent news:

*1 million new HIV patients in need of life-saving treatment were added to the ARV rolls in the developing world last year, for a total of 4 million people now getting HIV therapy in low- and middle-income countries

*HIV testing and counseling became more widely available and more frequently used last year

*Almost half, 45 percent, of HIV-positive pregnant women received ARVs to prevent transmission of the virus to their babies in 2008, up from 35 percent in 2007

Now for the hard part. More than five million people who desperately need treatment still aren’t getting it, concludes the report, “Toward Universal Access, Scaling up priority HIV/AIDS interventions in the health sector.” And although 1 million new HIV-positive people were put on ARVs last year, there were an estimated 2.7 million new infections in 2007, not exactly a good ratio. And many patients are not being diagnosed until they have end-stage disease, when HIV therapy may be too late. Click here for the news release, which summarizes the report.

“Without significant acceleration in the rate at which services are expanded and people are reached, millions of new infections will occur, more lives will be lost and the human and economic burden on future generations will continue to increase,” the report’s authors write in the conclusion.

And all these new numbers must been seen through the prism of new evidence demonstrating that earlier initiation of ART has a significant positive effect on mortality and survival; indeed, the authors of today’s report make a passing reference to the WHO’s plans to review the new scientific evidence on that matter and “proceed with any necessary revisions to its treatment guidelines” later this year. (more…)

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