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Posts Tagged ‘women’

The Center’s Rabita Aziz describes a visit to Livingstone General Hospital’s antiretroviral therapy (ART) ward in Zambia during a recent Congressional delegate trip to Africa.

In a dark room so small and cramped that the door won’t even close, Ndabila Singango, a provincial clinical mentor employed by the Center for Infectious Disease Research of Zambia (CIDRZ), tests and counsels HIV/AIDS patients at the Livingstone General Hospital. The hospital, built more than 60 years ago and used only by white colonists before Zambia gained independence, is the only hospital in all of Southern Province, which has a population of 1.6 million. With an HIV prevalence rate of 30 percent in Livingstone, it is not surprising that 80 percent of admissions to the hospital are HIV-related.

Gertrude, an HIV positive mother with newborn twins, explained that the lesions on her face appeared two weeks ago.

The ART ward of the hospital sees an average of 70 patients daily, and provides ART to 3500. When we met one such patient, Gertrude, she was breastfeeding one of her three-month old twins while the other – strapped to her back – slept peacefully.

Gertrude learned that she was infected with HIV/AIDS three years ago when she felt ill and was advised to take an HIV test. She had not disclosed her HIV status to her husband as she feared reprisal from him and the community. Like many African women, Gertrude was unable to negotiate the terms of sex, and therefore did not use protection.

When she started ART in November of 2008, Gertrude’s CD4 count was at 129. Six months of therapy later, it rose to just 130. (more…)

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The Interagency Youth Working Group worked with USAID to sponsor a meeting yesterday entitled “Protecting and Empowering Adolescent Girls: Evidence for the Global Health Initiative.”  The meeting featured a series of presentations from leaders in the global health field, which aimed to identify factors contributing to girls’ vulnerability to HIV and reproductive health risks, as well as to share effective programmatic approaches and research that address such risks.  In one of the panels, entitled “Empowering Adolescent Girls,” panelists spoke of their respective organization’s projects in developing countries, aimed at empowering young girls as a strategy to deal with the HIV/AIDS epidemic. 

Facilitator Victoria Collins, of Cardno Emerging Markets, discussed the need to invest in the development of young girls as a way to uplift entire communities.  Investing in young girls not only empowers them but empowers their families and ultimately, their whole communities.  Young girls and women in developing countries are often unable to negotiate sex on their terms and ensure their sexual safety, and are particularly vulnerable to being infected by HIV/AIDS as a result.  As HIV/AIDS is the leading cause of death among women of reproductive age worldwide, it is imperative that young women are equipped with the power and knowledge to protect themselves from being infected by the disease.

Worknesh Kereta, of Pathfinder International, spoke of her organization’s women and girl’s empowerment program in Ethiopia, in which they reached over eight million young girls and women with information about sexual and reproductive health, as one part of their multifaceted model to equip girls with the information, skills, and knowledge needed to empower themselves and their communities.  One of their aims is to reduce the prevalence of STI’s and HIV, and they plan to achieve this by spreading awareness of the disease. 

At the end of the program in 2009, 52 percent of women participating in the program had been tested for HIV, a 26 percent increase from the baseline.  In addition, 35 percent of the women were using modern contraceptives at the end of the program, up from 25 percent in 2007.  Kereta also emphasized the importance of reaching out to young boys before attitudes discriminatory towards women were formed as a way to promote gender equity in the future.

Betty Ochieng of Family Health International (FHI) discussed their “House-Girls Health and Life Skills Project” in Nairobi, Kenya, in which community development workers reached out to domestic workers, commonly known as “house-girls”, with the aim to equip these often illiterate and vulnerable young people with the skills and knowledge needed to ensure their sexual and reproductive health.  Of the 277 young women who directly participated in the program, half were sexually active, 12.5 percent had sex in exchange for money in the past, and seven percent had faced sexual violence.  

Because house-girls are often only allowed enough free time to attend church once a week, the program was implemented through churches, with congregation members acting as lead trainers.  In addition to the 277 that were reached through the program directly, 910 more were reached through 22 trained peer educators, and an estimated 27,830 were reached through media efforts.  HIV/AIDS and STI awareness greatly increased as a result of these efforts.

These projects illustrate how simple it can be to equip young women with the tools they need to empower themselves and consequently protect themselves from being infected by HIV/AIDS, and other STIs.

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Laura Hoemeke is Director of Strategic Communications at IntraHealth International, based in Chapel Hill, N.C. This post follows a discussion Monday at Aspen Institute on women’s health.

The Aspen Institute’s Ministerial Leadership Initiative panel discussion on Women and Health taught, or maybe reminded me, of three important lessons, among countless others.

Laura Hoemeke

First, as Dr. Susan Brems noted, policies and programs that successfully address the health of women do not treat them as “the vulnerable ones” or silent “beneficiaries,” but listen to women, respect women, and work with them as resilient agents of social change.

Second, as Dr. Tonya Nyagiro pointed out, ensuring that programs support infants, children and adolescents is just as important as supporting services for adult women that meet their health needs.

Third, as Dr. Julio Frenk and Michele Moloney-Kitts and other panelists reminded us, in developing policies and implementing programs, we need to remember that health workers and health systems are not only providing treatment and offering care, but also are offering primary health care, including health education and prevention (like family planning services!), and therefore need to supported in these roles and in light of their larger social and cultural networks.

It was invigorating to be a part of this celebration of International Women’s Day, and of the release of WHO’s new report, Women and Health: Today’s Evidence, Tomorrow’s Agenda. Dr. Frenk pointed out the importance of talking about “women and health” rather than “women’s health,” noting that women play many roles in influencing health, serving not only as caretakers, but also as members of the workforce and, especially the health workforce.

Moloney-Kitts emphasized the importance of making sure that “women’s voices influence our policies,” reminding us that violence against women still too often silences some of those voices. (With USAID support, IntraHealth has been able to work on some stimulating initiatives addressing the prevention and response to gender-based violence: http://www.intrahealth.org/page/gender-equality-1)

Moloney-Kitts also reminded us that too many women are still dying from HIV and AIDS—and that it’s not the time to pat ourselves on the back and cross our arms. All of the panelists agreed that family planning efforts need to continue, too, including innovations and support for new contraceptive technologies—ones that involve men as well as women.

The new WHO report, which includes an impressive compendium of information, should be read and consulted widely, and truly inform and influence public policy. As Dr. Brems noted, we need to roll out the tried and tested approaches—and ensure that innovations are truly innovative. (For example, is providing setups that allow women to deliver while they are squatting or not in a bed or wearing some of their clothes, preferences impacting health seeking behavior that were documented years ago, really an innovation today? When we know that something works, we don’t need to re-innovate, but to figure out how make it happen.)

The US Government’s new Global Health Initiative should ensure that “women’s voices influence our policies” and wholeheartedly make use all of the available evidence to meet its goal of “adopting a women and girl-centered approach” to the benefit of women, men and families and communities. The GHI has pledged to “support long-term systemic changes to remove barriers and increase access to quality services” for women, ensuring meaningful participation of women and girls in decision-making and involving men and boys in addressing gender equity. The right people, policies and programs can make this happen.

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The Global Center’s Christine Lubinski and David Bryden attended a State Department forum on HIV and gender Thursday. Here’s their report:

“HIV has a woman’s face.”  That statement was part of Melanne Verveer’s opening remarks Thursday at a State Department forum. Verveer, the Obama  Administration’s ambassador-at-large for global women’s issues, highlighted the now well-known facts about women and HIV: half of all HIV-infected  persons are women, with the proportion increasing to 60 percent in sub-Saharan Africa, and the special vulnerability of girls, which translates into a double to quadruple risk of contracting HIV compared to their young male counterparts.

She noted with urgency that HIV is a major factor in maternal mortality and cited alarming information from a study released this month that showed that maternal mortality ratios in Johannesburg, South Africa, in HIV-infected women are more than six times higher than in HIV-negative women.  “We really need to understand and work through this,” Verveer said.

She proceeded to identify the myriad factors that contribute to this epidemiological reality—from unequal power relationships between men and women, lack of educational and/or economic opportunities, the prevalence of gender violence—before turning to the Obama Administration’s Global Health Initiative.

A central principle of the GHI will be a woman-centered model of care and commitment to ensuring that women and their families have access to basic health care services, as well as disease-specific interventions. One example she highlighted, and was clearly personally outraged about, was a situation where a woman receives a PMTCT drug intervention, but neither the mother nor the child receives any follow up health care. She talked about structural changes in facilities and staff to make them more woman and family friendly. (more…)

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Yesterday we received more information about the budget proposal from President Obama.  There are some new details, such as his proposal to flat-fund US backing for the Global Fund.  His proposal does not add up, I am sorry to say, and it is not consistent with the Hyde-Lantos legislation the President co-sponsored last year.  Why does the current economic recession require essentially freezing programs that constitute less than a tenth of one percent of the budget? 

We addressed these issues in a conference call for reporters, which you can listen to online here.

And, we issued the statement below, which adds to my earlier posting, “The $63 billion dollar question” —

May 7, 2009

Global HIV/AIDS & TB Experts Disappointed with Obama Budget

Today the Obama Administration released further details about its fiscal 2010 budget proposal for global health programs, including HIV/AIDS and tuberculosis.

An analysis by the Global Center for Health Policy shows that, while some significant increases are promised for later years, the Administration is proposing FY 2010 funding levels for HIV and TB that fall far short of what is needed to address the urgency of these diseases.

Earlier this week, the Administration proposed that the US spend $63 billion on global health over a six year period, including the $48 billion for 2009-2013 already pledged in the Lantos-Hyde legislation passed last year. In presenting his strategy, the President stated, “public health crises abroad can cause widespread suffering, conflict, and economic contraction.”

The Administration said it would give greater emphasis to funding a range of programs, in particular, to address child and maternal health, family planning, and neglected tropical diseases; however, programs to address all of these urgent issues receive only a $93 million increase in the budget proposal for 2010.  The Administration stated its budget would reflect an investment in strengthening critically weak health systems, but there appears to be no additional funding for this purpose in 2010.

“The President is right about the urgency of global health, and $63 billion is an impressive number,” said the Center for Global Health Policy’s Director, Christine Lubinski.  “However, since HIV and TB are right now killing about 10,000 people a day, the real issue is what the Administration is requesting for 2010, not later in his term,” she stated. “These health emergencies will not wait until 2011, and, since both diseases are major drags on the global economy, it makes good economic sense to aggressively confront them.”

The Administration has proposed that the global HIV/AIDS program, PEPFAR, receive only a $100 million increase for 2010, far too low to maintain a basic level of momentum in the program.  This is especially true in the context of the global economic downturn, which means that recipient countries are facing severe difficulties in financing AIDS programs from their own national budgets and treatment shortages have resulted.

“Increases in the PEPFAR budget are needed to continue progress in expanding treatment access and to invest in prevention interventions, like male circumcision, that will save money in the long run,” said Ken Mayer, MD, co-chair of the Center’s Scientific Advisory Committee.  “Sadly, this budget is bound to stall the fragile progress made in saving lives with antiretroviral drugs and could force a self-defeating choice between providing treatment or greater prevention.”

As a part of its review process the Administration has stated a determination that every dollar be put to good use.  “We welcome this determination,” stated Lubinski.  “The Administration has promised a review of prevention approaches to ensure they are evidence based, and we look forward to seeing the results of this review,” she said.

Tuberculosis is also an enormous burden on developing countries, and last year the Lantos-Hyde legislation pledges $4 billion over five years for US bilateral TB programs.  However, the Administration has included only an additional $10 million in its global TB budget, a funding level would stall further progress against this killer disease.  With a projected authorization level of $650 million for global tuberculosis under Lantos-Hyde, the Administration’s proposed $173 million cannot be viewed as a reasonable down payment on activities ranging from TB control to research to bring new diagnostics and drugs to the field.

Another major disappointment for global health advocates is the Obama proposal for the Global Fund to Fight AIDS, TB and Malaria. Countries rely on the Fund, in particular, for funding for tuberculosis programs, and so far the Fund has also provided over $600 million for health system strengthening.  The Global Fund requested $2.7 billion from the US for 2010, but the Administration is proposing only $900 million, the same level as 2009.  Unless Congress goes above the Administration’s proposal, the US will miss a major opportunity to use the Fund to leverage more donations from Spain, Germany, and other countries, and AIDS, TB and malaria programs will be stalled.

Regrettably, biomedical research at the National Institutes of Health received only a modest $443 million increase.  Research is the engine that drives new drugs, diagnostics, vaccines and prevention interventions to effectively combat HIV and tuberculosis around the world

Congress will now consider the Administration’s proposals. First, they will consider the emergency supplemental budget for 2009 and whether to include global health funding.  The Global Fund is facing an overall gap in required contributions of between $4 and $5 billion over this year and next, and advocates are urging Congress to use the supplemental budget to deliver an immediate boost to the Fund.  Rep. Dave Obey has proposed $100 million in emergency funds for 2009 for the Global Fund, and health advocates are hoping the Senate will go even higher.

Congress will then turn to the FY 2010 appropriations bills, and Rep. Nita Lowey and Senator Patrick Leahy will lead this process for development aid.  Formal consideration of these bills is expected sometime next month, and IDSA will be encouraging Congress to increase funds for these lifesaving global health programs.

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The first female condom was a flop. Now a second version is making its debut around the globe. It remains to be seen whether this new and improved protection–the FC2–will prove more successful at empowering women to ward off HIV and other sexually transmitted diseases.

 

Click here for an interesting AP story on the issue, which notes that women shoulder an “ever-growing” burden of the AIDS epidemic.

 

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If you tuned in to NPR this morning, you probably heard Brenda Wilson’s story on the latest efforts to develop a pill or gel to protect women against HIV infection.

The piece highlights the frustration that more concrete progress has not been made. It has inspired a lively discussion from listeners posting comments on NPR’s website. Click here to listen and join the conversation. And post a comment here too!

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