The Daily Impact: Rising AIDS a Concern in Iran

December 3, 2013

The Health Minister of Iran, Hassan Hashemi, voiced concerns about the increase in AIDS cases across the country, on Monday. From AFP:

13920616000597_PhotoI“This disease has increased by 80 percent annually, which is much higher than the rise in inflation or rents,” he said, quoted in Shahrvand newspaper.

Hashemi criticised Iran’s hush-hush policy on AIDS.

Extra-marital sex is strictly prohibited in Iran, punishable by whipping and imprisonment.

“The pattern has changed from transmission of the infection through drug injection to unprotected sexual intercourse,” Hashemi said.

“We need to find new ways to fight AIDS and we should not be afraid to admit this is a problem of our society,” said the minister.

“There was a time that AIDS was used … to mock other societies, but now the entire world is struggling with this disease and we are no exception,” Hashemi said.

Ali Sayyari, Iran’s deputy health minister, blamed the phenomenon on satellite TV programmes, gyms and beauty salons, describing them as a “triangle of death”.

According to UN statistics, the number of people in Iran living with HIV reached 71,000 in 2012.

Iran has moved to fight the spread of AIDS by making condoms easily available in shops and educating the public of the consequences of sex with multiple partners.

On Sunday, World AIDS Day, the government announced plans to distribute AIDS leaflets in schools and special kits across Iran to easily diagnose the disease.

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Partnerships Help Defeat AIDS in Rwanda

By Dr. Anges Binagwaho, Minister of Health, Rwanda

The op-ed originally appeared in US News and World Report. It is based on an article she co-authored last week in the New England Journal of Medicine on the HRH program together with Paul Farmer, Eric Goosby and others. Available here.

binagwahoOver the past decade, we have made extraordinary gains against the world’s deadliest diseases thanks to the U.S. President’s Emergency Plan for AIDS Relief and The Global Fund to Fight AIDS, Tuberculosis, and Malaria. These initiatives are saving millions of lives every year. In order to make these gains truly sustainable, we must now address a critical challenge in low-income countries: an acute shortage of highly-trained health professionals.

While Sub-Saharan Africa bears 24 percent of the global disease burden, it’s served by only 4 percent of the global health workforce. As the World Health Organization just announced, the global health worker shortage stands at more than 7.2 million today and is expected to grow to 12.9 million by 2035.

A report that my colleagues and I published in the “New England Journal of Medicine” offers compelling new evidence about the power of partnership in helping Rwanda, my country, to overcome this obstacle. The Human Resources for Health program – financed by PEPFAR and The Global Fund – is building health care worker capacity in Rwanda over the next seven years to ensure that we can meet the pressing health challenges facing our people.

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The Daily Impact: Attention on Children Wanes in AIDS Fight

December 2, 2013

Concerns by the increase in the number of AIDS-related deaths among adolescents. Agencies are calling for more to be done to protect the front line. From GlobalPost:

kids-and-aids“The world now has the experience and the tools to achieve an AIDS-free generation,” UNICEF’s executive director Anthony Lake said in a statement.

“Children should be the first to benefit from our successes in defeating HIV, and the last to suffer when we fall short.”

One reason cited for the increase is that across sub-Saharan Africa, many young people who were infected at birth are now teenagers who need additional support to remain on treatment.

Another factor is that adolescents are especially vulnerable to sexual exploitation and abuse, putting them at high risk of HIV infection.

Craig McClure, chief of HIV programs for UNICEF, said that young people face barriers to testing, prevention and treatment, including harsh laws, stigma and discrimination.

“About one-seventh of all new HIV infections occur during adolescence. Unless the barriers are removed, the dream of an AIDS-free generation will never be realized,” McClure said.

In South Africa, which has more people living with HIV than any other country, health minister Aaron Motsoaledi has pointed to “sugar daddies” as a major factor in the spread of HIV, the virus that causes AIDS.

Young girls in South Africa are up to three times more likely than boys to become infected with the virus.

A recent study published in the medical journal Lancet Global Health found that in families receiving government child support grants, girls were two-thirds less likely to date older men for money, reducing their risk of getting HIV.

According to UNICEF and UNAIDS, new infections among adolescents could be halved by 2020 with additional and more focused funding. As of 2012, some 2.1 million adolescents worldwide were living with HIV.

The World Health Organization this week issued its first-ever recommendations on HIV and adolescents, including guidance on HIV testing and counseling, in order to make it easier for young people to get tested without parental consent.

“Adolescents need health services and support, tailored to their needs,” Gottfried Hirnschall, director of WHO’s HIV/AIDS department, said in a statement.

“They are less likely than adults to be tested for HIV and often need more support than adults to help them maintain care and to stick to treatment.”

The UN report praised progress made to prevent mother-to-child transmission of HIV. More than 850,000 new childhood infections were averted between 2005 and 2012 in low- and middle-income countries, it said.

Some 260,000 children were newly infected with HIV in 2012, compared to 540,000 in 2005, the report said, citing simplified daily antiretroviral treatment that helps prevent transmission of the virus to babies during pregnancy.

New infections among infants declined between 2009 and 2012 by 76 percent in Ghana, 58 percent in Namibia, 55 percent in Zimbabwe, 52 percent in Malawi and Botswana, and 50 percent in Zambia and Ethiopia.

Of the more than 35 million people worldwide who are infected with HIV, 25 million are in sub-Saharan Africa, though the rates vary significantly within these countries.

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World AIDS Day: Celebrating One Million

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By Donna Sherard, Deputy Director, Sexual, Reproductive Health and TB Department, PSI

Today, on World AIDS Day 2013, PSI and Alere are excited to announce that the one millionth HIV rapid test donated by Alere has landed on the ground in Zimbabwe. This moment is a cause for celebration as a further step toward achieving an AIDS-free generation.

Two years ago today PSI joined with Alere, a leading healthcare diagnostic company, to champion a commitment to increase access to rapid HIV testing. As part of this partnership, Alere donated one million HIV rapid tests as part of their ‘Make (+) More Positive’ campaign. The donation has aided 10 countries with the highest HIV prevalence and greatest need for tests in the world. The donation has also served to address critical gaps in test kit availability where PSI is the lead HIV testing provider.

PSI has worked to prevent and treat HIV and AIDS since the early days of the epidemic. In 1988, we began our first HIV prevention program in the Democratic Republic of Congo. Since then, PSI’s HIV prevention and treatment services have grown exponentially, and are now offered in over 60 countries around the world.

Together, through Alere’s state of the art rapid testing technology and PSI’s extensive distribution channels, these one million tests are helping people like Li*. For those who test positive, like Li and his wife, PSI provides the resources and support they need to live a full life.

“My wife and I have been injecting heroin for many years and we were both afraid that we might have been infected by HIV like many of our friends. We had heard about the Huxianghao Ba Clinic (HXH**) before but had never dared to go there. One of my best friends invited my wife and me to attend a gathering at HXH. During the party, an HXH staff member named Mei* talked to us about HIV and AIDS and asked us whether we would like to get tested, saying that we would know the results in just a few minutes. We both decided to do it.

My heart sank when Mei explained to us that both of our results were HIV positive. Mei then shared with us that she too, was HIV positive. She told us that at first she had a very difficult time accepting her status. Despite her fear of how others in her community would react, or how the disease would affect her livelihood, Mei sought counseling and treatment, and eventually joined PSI as a peer educator. That night, Mei talked with a smile about her current life, about her job, and about her family. She seemed to be positive about life and living with her status.

Remembering Mei’s story really helped my wife and me feel better about our positive status. We visited the doctor at the infectious hospital where Mei referred us. The doctor gave us a confirmatory test and a CD4 count test. We are now both seeking treatment and moving forward positively with knowledge of how to live with HIV. My wife and I will work together to stay healthy and face the future together.”

For people like Li and Mei and the countless others living with HIV, PSI and Alere will continue to work towards an AIDS-free generation, empowering others to stay healthy and face the future positively.

*Names have been changed to protect identities.

** HXH was formerly part of the PSI Clinical Health Network in China.

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Value for Money: Narrative vs. Number

By Allison Beattie, Ph.D.

We in the development community have likely all wrestled with the concept of “value for money.” While it sounds straightforward, the concept can be difficult to pin down. This is because value for money is not only what is cheapest or most evidence-based or even what responds most immediately to an identified bottle-neck. The final decision hinges on a narrative rather than a number, and human judgment rather than money and formulas.

Demonstrating good value for money requires making the case that in a particular context, using available resources in the proposed way will deliver the best outcome and impact. At DFID, we have circled round the issue a number of times looking for ways to improve and strengthen our focus on value for money without losing vision or cutting edge thinking. In the end, a case for investment, centered on a compelling value for money narrative, has several key ingredients:

➤ ACCURATE STATEMENT OF THE PROBLEM: Defining with precision the problem that a program aims to address is the essential starting point and can often be overlooked in favor of a broader analysis.

➤ EVIDENCE REVIEW: Evidence may include more than just proof that an intervention delivers a specific outcome and could also include cost-effectiveness data and efficiency data. If evidence is in short supply or inconclusive, the value for money narrative should explain how an approach will build or strengthen evidence.

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Combination Prevention with the Fishermen of La Pirraya: Reaching the most inaccessible areas of El Salvador

“The other fishermen don’t want to be tested because they’re afraid, but sure, test me, I get tested every year,” says José Luis Figueroa, a fisherman who lives on the island of La Pirraya, (located 100 kilometers from San Salvador, south of Usulután in El Salvador).

The island is renowned for being one of the most difficult places to access in the country, both for traders and the general public. “Our grandfathers and our fathers, they have dedicated their lives to fishing here and so have we. It wouldn’t be easy for us to leave,” adds José Luis, when asked about his way of life.

José, due to his occupation, is considered to be a man at-risk for HIV under the USAID Combination Prevention Program for HIV, whose implementing partner, the Pan American Social Marketing Organization (PASMO) and other partners, seek to reach under a strategy known as “sweeping the zone”. This strategy works through multidisciplinary teams who identify, map and target specific geographical high-risk areas or regions of the country to reach most at-risk and vulnerable populations with the complete essential or minimum package of combination prevention services. In El Salvador, only 45% of at-risk men use condoms, while 35% engage in casual sexual relationships.

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The Daily Impact: World Draws Closer to Beginning of the End of AIDS

November 27, 2013

A single solution to differing problems regarding tackling AIDS is no longer possible. Change is needed to achieve major advancements, says the ONE Campaign in a new report. From VOA:

In an analysis of the state of the global fight against the human immunodeficiency virus (HIV) and AIDS, the advocacy group ONE said that while some African countries had reached a “tipping point” against the disease, others lag far behind.

More than 35 million people worldwide are infected with HIV, which causes AIDS. Of that 35 million, 25 million are in sub-Saharan Africa. Yet within Africa, rates of HIV and AIDS vary widely.

“Our analysis shows major distinctions between leaders and laggards, and that a one-size-fits-all approach to tackling AIDS on the continent does not make sense,” said Erin Hohlfelder, ONE’s global health policy director.

“It’s no longer useful to talk about AIDS from a continent-wide perspective… It’s time to retire the phrase, ‘AIDS in Africa’,” continued Hohlfelder.

ONE is an advocacy group co-founded by U2 front man Bono, committed to fighting to end poverty and preventable disease, particularly in Africa.

According to its report, 16 countries in sub-Saharan Africa have reached what experts describe as the “beginning of the end of AIDS” – a point when the total number of new HIV infections is lower than the number of patients newly receiving AIDS treatment in the same year.

Leading the pack are countries such as Ghana, Malawi and Zambia, where governments, international donors and civil society leaders have worked together, the report said, and as a result have made dramatic progress against HIV/AIDS.

Yet at the same time, other countries, such as Cameroon, Nigeria and Togo, lag far behind, often hampered by a lack of political will to tackle HIV, inadequate funding, poor delivery systems and stigma against marginalized populations where HIV infections are more frequent.

“Increasingly, both in terms of how we talk about the disease and also how we fight it, it makes more sense to look country by country, even community by community… Then, we can think about what progress we’ve made, what challenges remain and how best to put resources into tackling them,” said Hohlfelder.

Looking globally, the ONE report found significant progress towards achieving “the beginning of the end of AIDS”.

“If current rates of progress continue, the world can reach that milestone by 2015,” the report stated.

Hohlfelder cautioned, however, that getting there is “not a foregone conclusion”, but depends on donors and affected countries doing more together to ensure HIV treatment and prevention services reach all those who need them.

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The Most Meaningful Metric is Lives Saved

By Deborrah Derrick, Friends of the FIght Against AIDS, Tuberculosis and Malaria

Clear metrics can be hard to come by, but there are no shortage of indicators pointing to the critical moment in which we find ourselves with respect to AIDS, tuberculosis and malaria. Worldwide efforts have reduced HIV incidence by 33 percent, tuberculosis deaths by more than 40 percent, and malaria deaths in Africa by 33 percent in the past five to 10 years. A number of recent and dramatic scientific advances and improved epidemiological data, combined with implementation experience, could enable us to finally turn the tide on these plagues.

But there is strong scientific evidence to suggest that taking our foot off of the gas pedal now   could allow these epidemics to come roaring back; one need only look at the history of malaria eradication efforts to see this. As the world’s most powerful tool in this fight, the Global Fund to Fight AIDS, Tuberculosis and Malaria is working to make full use of these recent advances and the knowledge we have gained to maximize the return on our collective global health investments.

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The Daily Impact: UN Concerned About Link Between Violence and HIV

November 26, 2013

The UN called attention to the International Day to End Violence Against Women by showing the connection between violence and HIV. From VOA:

PHOTO MISSION UNAIDS/UNFPAThe Joint United Nations Program on HIV/AIDS – UNAIDS – says every hour 50 young women become newly infected with HIV. Many of those infections are related to violence.

“Lots of the gender-based violence [is] sexually related. There is a lot of data right now showing that most of the violence against women happens in the context of intimate partner violence – domestic violence. And many times it takes the face of non-consensual sex, which is a polite way to say rape,” said Dr. Mariangela Simao is UNAIDS Director of Rights, Gender, Prevention and Mobilization.

Simao said gender-based violence is strongly linked to HIV/AIDS.

“In some countries where there’s a high prevalence, it’s been shown that women who are subjected to intimate partner violence, sexual violence, are 50 percent more likely to be HIV positive than other women. The gender inequality, the gender disparity also, [do not] allow women to negotiate, for example, for safe sex. If, for example, they think that their partner’s been fooling around or being unfaithful in different situations, they [cannot] ask for him to use a condom.”

Many sexworkers are also frequent victims of violence and are unable to have safe sex.

“There’s a recent report from WHO [World Health organization] that shows that one in every three women – that’s a global report, ok – experience physical or sexual violence by a partner in their lifetime. One out of three women. So it’s not a localized problem in developing countries or least developing countries. It’s a global problem,” she said.

The World Health Organization report also said up to 45-percent of adolescent girls globally say their first sexual experience was forced. Violence against women includes coerced abortion and forced sterilization.

The UNAIDS official said that many times sexual or gender-based violence happens under the guise of culture or tradition.

“The right of women to live free of violence and inequities is a human right. And it shouldn’t be bound by culture and by norms that rule society that are unjust.”

She said empowering women would help end the violence. That begins with girls through education and an awareness of their rights. But she also says men must play a big role in solving the problem.

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Reflections on Recife and the Global Health Workforce: Metrics and Motivations

By Michael Bzdak; Executive Director, Johnson & Johnson Worldwide Corporate Contributions

The Third Global Forum on Human Resources for Health has concluded and although the issue of human resources for health is enjoying an uptick of attention within the international community, it is clear that much more needs to be done to support and honor existing workers while at the same time attracting new entrants into the health workforce. And honor them we must. Without urgent attention, there will be a projected shortage of more than 12 million health workers by 2035.

Two themes came up a number of times throughout the forum, providing a consistent and hard-to- ignore drumbeat. First, it is apparent that in our collective quest to make sure that everyone has access to well-trained, competent and culturally-sensitive health workers, we have to improve our collection of reliable data and ensure that we have functional and reliable human resource databases in every region of the world. It is no surprise that GHWA and WHO recognize this as a key recommended action – and a number of organizations are stepping up to the plate with solutions to what has been a stubborn problem.

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