Supply chains—a lifeline for HIV programs

By Anne Marie Hvid, Knowledge Management Advisor, JSI and Sarah Hiller, Communications Technology Coordinator. This originally appears on the JSI.

HIV and AIDS advocates highlight progress in treatment programs, but in developing countries, otherwise successful programs are stopped in their tracks because of limited supplies. At the AIDS 2012 conference in Washington, DC, the International Association for Public Health Logisticians (IAPHL) is talking to HIV and AIDS service providers and providing resources on how to solve supply chain management problems.

The need for improved supply chains is evident in the stories told by conference attendees. We met Tope Aboyewa, a senior programme officer with the Kids and Teens Resource Center in Nigeria, at the IAPHL booth in the Global Village area of the conference. His center, which provides HIV counseling and testing services, has been stocked out of HIV test kits since 2010, aside from sporadic donations of supplies from partner organizations. When the center had enough kits, they were testing around ten people a day; now that test kits are scarce they have to turn people away.

Gertrude Mushabe, a delegate from the Bethesda Project in Uganda, runs a mobile community health unit and echoes Aboyewa’s experience. “If we had more supplies, we could help more people. The need is there, the community is there, we just need the supplies.” Her mobile health unit goes to rural areas and villages in the three districts with the least access to care, but the unit is often stocked out of supplies, including malaria, HIV test kits, and other products, like gloves.

“Combination Prevention” is Necessary, But Must be Done Right

The following post is a part of an exclusive series from global health experts to mark the International AIDS Conference. Read the other posts here.

By Dr. Daniel Halperin, Adjunct Associate Professor, University of North Carolina, Gillings School of Global Public Health, Chapel Hill

It should be obvious that to really turn the tide against this pandemic, a variety of approaches –or what’s been termed “combination prevention” — will be necessary. Yet multiple approaches for HIV prevention have been used for decades, so why has this slogan emerged in recent years as a seemingly innovative response?

The increasingly forceful calls for “combination prevention” may have arisen partly in response to evolving research and papers (such as a 2008 Science policy piece by ten experts) pointing to the importance of focusing on newer approaches, including male circumcision and addressing multiple concurrent partnerships, as well as noting the apparent lack of strong evidence for some conventional approaches. Thus some of those who advocate for combination prevention may be resisting such refocusing of prevention priorities because of a perceived threat that interest in some newer approaches may mean less funding for older approaches and modalities.

All HIV experts agree that a combination of approaches is needed. This does not mean, however, that continuing to do the same things we’ve been doing all along, but doing them all at once or in greater quantity will somehow make them effective. If combination prevention essentially becomes a laundry list of many different elements that all need to be pursued with equal intensity, regardless of their likely effectiveness, then resources will not be spent optimally and fewer new HIV infections will be averted. Of paramount importance is to prioritize those few (typically only two or three) most important approaches that absolutely need to be focused on, for each epidemic’s particular context. This does not mean only implementing (and funding) those strategies, but for example the endlessly long lists of “prevention activities” comprising many national “strategic” plans undermine the strategic objective of such documents.

Prevention as Prevention: A continuing role for educational interventions around concurrency

The following post is a part of an exclusive series from global health experts to mark the International AIDS Conference. Read the other posts here.

By Martina Morris and Helen Epstein

The debate about the importance of concurrent or overlapping sexual relationships continues.  The hypothesis initially gained ground because it explained an important paradox in Southern and Eastern Africa. The countries in this region are home to 65% of all new HIV cases each year, and up to 1/3 of adults in some communities are infected.  But surveys consistently show that the number of sexual partners is no higher than in Western countries where the epidemic is concentrated in high risk groups [1].  This is especially true for women, who bear a disproportionate burden of infection in high prevalence countries.  The evidence that people in the South and East African region are more likely to have a few long term concurrent partners provides an explanation for this paradox.  If enough people engage in such relationships, a sexual network emerges that provides ideal conditions for the spread of HIV:  high network connectivity, and maximal impact from the high viremia in early infection [2,3].

Last year the HPTN052 trial found a 96% reduction in HIV incidence among discordant couples when the infected partner is treated immediately after diagnosis.  Secretary Hillary Clinton and others have called for the rollout of this intervention at a population scale in high incidence heterosexual communities to bring the epidemic under control.

So does concurrency still matter for HIV prevention?

Male Circumcision and Turning the Tide

By Bertran Auvert

Five years ago, WHO and UNAIDS recognized and recommended male circumcision as an important strategy for the prevention of heterosexually acquired HIV infection in men in high prevalence countries with low levels of male circumcision.

What have we done so far in Eastern and Southern Africa?

The protective effect of male circumcision against acquisition of Human Papilloma Virus and the virus causing genital herpes has been demonstrated. Research has been conducted to guide and facilitate program implementation. A minimum package was defined and tools to assist scale-up were disseminated. An easy and safe surgical procedure was developed. We now have the scientific evidence that male circumcision does not result in increased HIV risk behavior. Studies demonstrated that uptake reaches high levels when male circumcision is vigorously promoted. After several years of intensive research, no major obstacle could be identified to justify a delay in scaling up male circumcision in Eastern and Southern Africa, regions with the worst HIV epidemics.

Can we turn the tide with male circumcision?

Modeling studies suggest that its generalization in sub-Saharan Africa could prevent millions of new HIV infections while saving several billions of US dollars from averted treatment. We know that HIV prevalence is relatively low in African countries where all men are circumcised. We know that male circumcision is at least 60% effective in reducing the female-to-male transmission of HIV. We know that male circumcision is a minor surgical procedure that can be performed safely in African countries. We know that male circumcision is complementary to other prevention methods such as condom use and reduction of risky sexual behavior.

ARV-based Prevention: A Promising HIV Prevention Option for Men and Women

By Mitchell Warren, Executive Director, AVAC

In the two years since the last International AIDS Conference, we’ve begun to talk seriously about ending the AIDS epidemic in our lifetime. And it’s not just rhetoric. Recent breakthroughs in antiretroviral (ARV) based prevention are key to turning the tide on the epidemic.

Two years ago in Vienna, we heard the amazing news from the CAPRISA 004 trial that an ARV-based vaginal gel could prevent HIV infection among some women. Since then results from several major trials of oral pre-exposure prophylaxis(or PrEP) have shown that HIV-negative men and women who consistently take a daily ARV pill are protected from HIV infection. The evidence is clear: ARV-based prevention works when people use it as prescribed.  In other words, when you have the right drug in the right place at the right time, you can reduce the risk of HIV infection.

ARV-based prevention will never be the answer for everyone at risk of HIV infection, but it is an important new choice in a combination of prevention options that includes male and female condoms, behavior change, harm reduction, voluntary medical male circumcision, and early and consistent treatment for HIV-positive people.

Aid for AIDS: Whither US Policy?

By Till Bärnighausen, David E. Bloom and Salal Humair

Barely three weeks before the 2012 International AIDS Conference (AIDS 2012), the US Government announced the closure of its Global Health Initiative (GHI) office (GHI, 2012). The impact of this closure on global HIV/AIDS programs is certain to be a major topic of conversation at the conference. Although the official position is that GHI’s core functions will be maintained under a different organizational structure, many global health activists and commentators fear that the organizational rearrangement will go hand-in-hand with substantial cuts in budget allocations for global health, threatening continuation of past programs, in particular the large scale-up of antiretroviral treatment (ART) in Africa in recent years  (Garrett, 2012). The new structure that will replace GHI has not been publicly announced, but speculation is that global health programs in a country will be put under US ambassadors (Garrett, 2012GHI, 2012), apparently to make the programs a more integrated part of US diplomacy.

GHI was launched in 2009 for two main reasons: first, to coordinate the global health programs of multiple US government agencies (e.g., PEPFAR, CDC, USAID), particularly after the rapid and somewhat haphazard expansion of US global health programs from 2003-2008, primarily led by PEPFAR; and second, to broaden the disease-specific focus of these programs to encompass strengthening of health systems. The hope was that unifying programs under GHI would lead towards more effective utilization of resources and that broadening their focus, in partnership with recipient countries, would encourage greater country ownership of health interventions. The ultimate goal was sustainable gains from global health interventions.

International AIDS Conference and Getting tested for HIV/AIDS: Should I do it?

This post originally appears on the Children’s Safe Drinking Water blog.

Next week, the International AIDS Conference (AIDS 2012) will be held in Washington DC.  This is a huge meeting with more than 20,000 participants and it’s the first time in 25 years that it will be held in the U.S.  P&G will participate in three different events at the AIDS 2012 meeting including co-leading a panel on water, sanitation, and hygiene (WASH) for people living with HIV/AIDS.  I’m thrilled to have the honor to introduce Debra Messing at the panel.  Debra recently traveled as a PSI ambassador to Zambia where she did a demonstration of the P&G water purification packets for people living with HIV/AIDS.

To celebrate the AIDS 2012 meeting, I’m posting this blog from my most recent trip to Africa.  It summarizes an eCHAI buckets 2motional day for me and I hope it makes my readers think about the importance of testing for the HIV virus.HIV/AIDS remains a leading killer of adults in Africa.  But, great progress has been made through the development of antiretroviral drugs.  Because of these life-saving drugs, having HIV/AIDS is no longer a death sentence and people can live positively with the virus.  One of the most important ways to attack this pandemic is for people to be tested and then to take antiretroviral drugs if they have the virus.  Recent research by the UNC Medical School has shown that that treatment with antiretroviral drugs can reduce transmission of the virus by more than 90% among couples where one person had the virus and the other did not.

And, the pandemic is not only in Africa.  For example, the CDC estimates that 1.2 million people in the U.S. are living with HIV infection.  New infections continue at far too high of a level, with approximately 50,000 Americans becoming infected with HIV each year.  And, the CDC estimates that 20% of people are infected and not aware of their status.

Hangin’ With PSI at the International AIDS Conference

Come join 60 PSI staff at the International AIDS Conference in Washington DC this week. Keep an eye on this blog for exclusive blog posts and coverage and come join us at the following events:

MONDAY, JULY 23

Voluntary Medical Male Circumcision: Call for Action for Maximum Public Health Impact
6:30pm – 8:30pm | Session Room 8

Hosted by PEPFAR, UNAIDS, WHO, AVAC, Champions for an HIV-Free Generation

If voluntary medical male circumcision (VMMC) is scaled up to 80% of adult men within five years, it has the potential to avert more than 3.4 million new HIV infections and save an estimated U.S. $16.5 billion in care and treatment costs. This satellite session will focus on the critical role that communication and advocacy play in accelerating the scale up of VMMC. African political and traditional leaders will join key figures in the international HIV response to discuss challenges, lessons learned and the road ahead.

Speakers: 
Dr. Oburu Odinga, Ministry of Finance, Kenya
Prof. Peter Anyang’ Nyong’o, Ministry of Medical Services, Kenya
Mr. Blessing Chebundo, Zimbabwean Parliament
His Royal Highness Chief Sengwa, Zimbabwe
His Royal Highness Chief Mumena XI, Zambia
Dr. Bernhard Schwartländer, UNAIDS
Dr. Jean-Baptiste Roungou, WHO
Angelo Kaggwa, AVAC
Hendrica Okondo, Young Women’s Christian Association