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Posts Tagged ‘UNAIDS’

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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This post is by the Global Center’s Rabita Aziz.

Photos and video by David Bryden.

A panel consisting of Haitian HIV advocates spoke today about the situation of HIV patients in a post-earthquake Haiti at a Senate briefing called “Report from the Frontlines: Living with HIV/AIDS in Haiti Post-Earthquake.”  The briefing was sponsored by Senator Kirsten Gillibrand, a member of the Foreign Relations Committee who is visiting Haiti this week with Delegate Eleanor Holmes Norton and Senator Mary Landrieu, who sits on the Appropriations Committee.   Other sponsors include Health GAP, UNAIDS, Partners in Health and Housing Works

With an HIV prevalence rate between four and five percent in the capital of Port-au-Prince, Haiti faces an even larger HIV epidemic on top of a humanitarian crisis thanks to the 7.0 magnitude earthquake.

The panelists, two of whom are living with HIV, discussed the problems faced by people living with HIV in a country where most of the health infrastructure was destroyed during the January 12th earthquake.

While the survivors praised past U.S. contributions to the fight against HIV/AIDS, they expressed disappointment that President Obama’s FY 2010 Haiti Supplemental Request for USAID and the State Department, which includes $893 million for recovery and reconstruction efforts, has no mention of funding for responding to the HIV/AIDS epidemic. 

The panelists stated that this lack of funding could result in thousands more becoming infected with HIV, and the reversal of ground gained thanks to PEPFAR dollars.  Fewer than 40 percent of Haitians who were receiving AIDS-related care prior to the earthquake are receiving it now. 

The lack of access to treatment may result in higher viral loads in patients, which increases the likelihood for transmission.  The advocates stressed that treatment must be scaled up to save lives and prevent new infections from occurring.

At the time of the earthquake Liony Accelus, president of the HIV/AIDS advocacy group REHPIHIV, was at a Country Coordinating Mechanism meeting to decide on which aid groups would be primary recipients of Global Fund dollars.  Everyone present at the meeting began to run out as the building began to crumble.  At this point he witnessed hundreds of other people fleeing into the streets to avoid being crushed by crumbling buildings.

Liony Accelus speaks about living in Haiti after the earthquake.

Upon discovering that all phone lines were down Accelus went to his home, only to discover that it had been destroyed.  For the next week, Accelus and his family lived in the streets and slept under the stars.  He was eventually able to obtain a tent, and is living in the tent with his family to this day.  Although he continues to live in such dismal conditions, he considers himself lucky in comparison to other people living with HIV who have no access to shelter or food, let alone to treatment. 

Haiti has an HIV prevalence rate of 2.2 percent.  At the time of the earthquake, there were approximately 120,000 people living with HIV, of whom 43,000 were in line to receive treatment.  The earthquake destroyed 46 hospitals and clinics and severely damaged 38 more, and has made it extremely difficult to obtain HIV drugs. 

The panelists stated that most HIV patients are now without shelter, and on top of that face an eight hour wait in a distribution line to receive food.  These conditions will greatly exacerbate their conditions while increasing chances for new infections.

Esther Boucicault, president of PHAP+ and FEBS, both coalitions made up of people living with HIV, discussed the response by other HIV advocacy groups after the earthquake.  Boucicault first reached out to Housing Works, a cosponsor of the briefing, which helped put together three clinics to address the medical needs of HIV patients.  Partners in Health (PIH), another sponsor of the event, provided medications and ARV treatment within days as well. 

Boucicault said she received no reply from the government when her groups reached out for direct assistance.  Although these groups provided much needed assistance, they don’t have the capacity to provide assistance for the tens of thousands of patients who need it.  Boucicault stated that the earthquake had taken the lives of between 200,000 and 300,000 people, and that the same number would become infected with HIV if further actions are not taken to address the problem. 

Edner Boucicaut, chief communications officer for CECOSIDA, spoke of the high risk of new infections due to the lack of access to treatment and medications, and to proper housing.  “Conditions remain the same,” he said when speaking of the daily fight people have to endure to obtain the most basic necessities.  With just two clinics in Port-au-Prince providing HIV medications, he spoke of the daily struggle of HIV patients to get their drugs. 

He stated that marginalized groups are at a great risk to contract HIV.  In many shanty towns and tent cities, women are forced to engage in prostitution at night to obtain vouchers to get food the next morning.  Patients living in close quarters with relatives face stigma and discrimination when their HIV status is disclosed to relatives. 

Dr. Wesler Lambert, director of monitoring and evaluation for Zanmi Lasante, PIH’s flagship project in Haiti, gave an account of how PEPFAR funding has turned around Haiti’s HIV epidemic in recent years.  Zanmi Lasante provided ART to 2,377 patients in 2006, and that number jumped to 4,716 in 2009 due to PEPFAR funding.  While more than 39,000 were tested and received counseling in 2005, more than 77,000 received the same services in 2009. 

The organization has set up mobile clinics in Port-au-Prince since the earthquake, and has treated over 45,000 patients.  Of the 4,127 tested for HIV, 75 tested positive.  Dr. Lambert called for an increase in PEPFAR funding to address the emerging threat of new infections caused by the failure of health systems.

John Hassell discusses the need for increased funding to respond to the HIV situation in Haiti.

In his closing remarks John Hassell, the Washington director of UNAIDS, expressed his concern over the lack of language about HIV/AIDS in the 2010 Haiti supplemental funding request.  No funding is included to help rebuild the HIV response through PEPFAR.  PEPFAR dollars allocated to Haiti for this year are insufficient to meet the increased post-earthquake needs for reconstruction of physical infrastructure, recruitment and employment of health workers, and purchase and distribution of commodities such as condoms and drugs. 

The organizations involved in the briefing recommend that an additional $100 million in supplemental funding be included for FY 2010 to rebuild clinics, provide drugs, train health workers, and set up prevention programs.  UNAIDS has released a paper which provides a situational analysis of the AIDS response in Haiti, and details what needs to be done to deal with the problem.  The paper can be found here

Watch Esther Boucicault discuss the AIDS response in Haiti after the earthquake here.

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This post is by the Global Center’s Rabita Aziz.

UNAIDS has launched a five-year action plan to address gender inequalities and human rights violations that put women and girls at risk of HIV infection.  The Agenda for Accelerated Country Action for Women, Girls, Gender Equality and HIV calls on the UN system to support governments, civil society and development partners in reinforcing country actions to put women and girls at the center of the AIDS response, and to ensure that their rights are protected.  This new operational plan identifies key actions which build on initiatives already in place, with the aim to support women and girls to claim their rights and to meet their HIV-related needs. 

Dr. Jantine Jacobi, the new head of the Gender and AIDS team at UNAIDS, joined with Center for Health and Gender Equality President Serra Sippel to present the Agenda to a room-full of women’s rights and global health advocates on Wednesday.  Jacobi expressed her agreement with UNAIDS Executive Director Michel Sidibe, who said, “Violence against women is unacceptable and must not be tolerated… By robbing them of their dignity, we are losing the opportunity to tap half the potential of mankind to achieve the Millennium Development Goals. Women and girls are not victims, they are the driving force that brings about social transformation.” 

The lack of control over their own sexuality that many women face is in part a result of other barriers they face,  such as in access to education or jobs, property ownership, and in cultural norms that limit their control over their own reproductive lives.   Sexual violence is a very real threat for many women and greatly increases their vulnerability to HIV infection.  To emphasis this point, Dr. Jacobi stated that a woman gets raped every single minute in South Africa.  Furthermore, HIV prevalence among young women aged 15–24 years is on average about three times higher than among men of the same age in South Africa, while 60 percent of people infected with HIV in sub-Saharan Africa are women.  HIV is the leading cause of death among women of reproductive age worldwide.  These stark numbers illustrate the urgent need to address women’s rights in relation to the HIV epidemic, and reverse these disturbing trends. 

The Agenda was developed through a consultative process conducted by the Global Task Force on Women, Girls, Gender Equality and HIV, and led by Professor Sheila Tlou, former Minister of Health of Botswana, and Michel Sidibe.  The Global Task Force and its working groups are comprised of high-level leaders and experts from 51 countries, including representatives from civil rights and women’s rights groups, government, academia, the UN system, and networks of women living with HIV.  The Agenda focuses on country-level action, and highlights opportunities to work with networks of women living with HIV and diverse women’s groups, while engaging men and boys.  It is structured around three issues:

  • Knowing, understanding and responding to the particular and various effects of the HIV epidemic on women and girls.
  • Translating political commitments into scaled-up action to address the rights and needs of women and girls in the context of HIV
  • An enabling community for the fulfillment of women’s and girls’ human rights and their empowerment, in the context of HIV.

The Agenda identifies 26 actions that should be undertaken to address these issues.  Some of these include:

  • Equip and support women’s groups and networks of women living with HIV to collect and use data on how the epidemic affects women and girls in order to monitor programs to assess their human rights impact and to contribute to national data collection.
  • Facilitate the launch of “know your rights” campaigns and support the provision of free and accessible legal aid services to enable women and girls to claim their rights.
  • Advocate for and support access to country-level comprehensive sexuality education that promotes gender equality and that equips young people with the evidence-informed knowledge, skills, and resources necessary to enable them to make responsible choices about their social and sexual relationships. 

Dr. Jacobi described these action steps as a menu from which countries can select and implement actions that work best for them.  The operational plan will first be rolled out in Liberia.  UNAIDS aims to have their teams implementing at least one component of the action agenda in 30 countries by the end of this year. 

Women’s organizations are enthusiastic about the Agenda.  When asked about her general impression of the Agenda, Jamila Taylor, a women’s rights advocate said, “I can say that the plan looks promising and that women’s groups are looking forward to working with UNAIDS as the plan is operationalized.  I commend UNAIDS for prioritizing women, and dedicating the resources in order to instigate action behind the words.”   When asked what the biggest gap is in U.S. leadership in addressing key concerns in women’s rights and HIV, Dr. Jacobi stated that a restriction on funding is the biggest problem.

Read the Agenda here.

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

The opening day of CROI included a session on the future of PEPFAR, featuring the US lead on global AIDS, Ambassador Eric Goosby, MD, as well as the health minister of Namibia and the UNAIDS deputy director.  Kevin De Cock, MD, recently named the head of global health at the CDC, moderated the session.

Goosby opened his talk by assuring this HIV scientific audience that the Obama Administration is focused on “maintaining, extending and increasing” the US response to global AIDS and described the President’s FY 11  $7 billion for PEPFAR, the largest request to date.  (Presumably, this $7 billion figure includes bilateral global TB activities as well as the Administration’s request for the Global Fund—which actually reflects a net  reduction from the amount that was appropriated for the current fiscal year.) Goosby talked about using key lessons learned to build the future of PEPFAR. He catalogued those lessons as follows:

*The HIV response has benefited both health systems and health status with, for example, reductions in hospitalization, coinfection, and  stigma

*Goals and targets help to drive programs and need to be modified as programs mature

*Prevention programs require targeted, data-driven responses

*Emergency response mechanisms must be supplanted with efforts to build country capacity to develop and coordinate a response to the epidemic

*The US must be able to demonstrate the impact of every dollar we spend.

Goosby then highlighted some of the major components of the new 5-year PEPFAR strategy, released in December:

  • Promotion of sustainable country programs
  • Strengthening partner government capacity
  • Expansion of prevention, care, and treatment in both concentrated and generalized epidemics
  • Integration and coordination of  HIV programs with broader global health and development programs
  • Investments in innovation and operations research.

Ambassador Goosby told the audience that his office was actively engaged in dialogue with the Global Fund , other bilateral programs, and foundations about ways to effectively converge resources and to identify efficiencies and savings.   As he has frequently done in other public statements, he spoke about the need for country ownership, but he explicitly described this as ownership by country and civil society.  This inclusion of civil society will no doubt be reassuring to some, but so far, civil society participation in the development of the 5-year partnership frameworks that the Office of the Global AIDS Coordinator is working on with a number of countries has been extremely variable and quite limited in some contexts.  He also pointed out that in most cases, in the near term, country ownership was more about control in identifying priorities and administering programs than actually providing the financing.  In particular, he highlighted transitioning to local partners as the dominant source for service delivery.

He noted that he thought that PEPFAR could make an important contribution to the global evidence base around effective prevention and described prevention as a combination of biomedical interventions, behavioral interventions, and structural/policy and social changes.

In regard to HIV treatment, Goosby said that expanding treatment and ensuring quality would continue to be a priority as the program moved from providing treatment access to 2.4 million to the “mid 4 millions.”  PEPFAR would also continue to provide technical support around treatment guidelines, ensuring retention adherence, and monitoring drug resistance.   PEPFAR is also committed to maximizing the use of pooled procurement for drugs and laboratory commodities and the use of generic ARVs , which is currently 89 percent. (more…)

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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 new UNAIDS report out today—an epidemic update—highlights key strides made in HIV prevention.

New HIV infections have been reduced by 17% over the past eight years, the new UNAIDS data shows, including declines in sub-Saharan Africa, East Asia and elsewhere. The report also says that the number of AIDS-related deaths has dropped by more than 10 percent in the last five years and estimates some 2.9 million lives have been saved by global HIV treatment initiatives.

“We cannot let this momentum wane,” said Dr Margaret Chan, Director General of WHO, according to a press release accompanying the report. “Now is the time to redouble our efforts, and save many more lives.”

Despite these gains, the document says prevention efforts are lagging behind changes in the epidemic, failing to reach key populations, including sex workers and injecting drug users. Read the full report here or the press release here.

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