Building the evidence base for preventing HIV among key populations

An HIV rapid testing kit. (Credit: John Rae/PSI)

Evidence of effective HIV prevention for key populations is an urgent need. Too often these programs remain small-scale pilots and never reach intended scale, while evaluations are sparse because target populations are hard to reach. PSI network members and their partners are looking to change that.

In Liberia, youth are taking action to improve their health

At a Clinic Celebration Day for HIV testing and contraceptives education and distribution - the capstone of the HealthyActions curriculum for youth developed with PSI's support in Liberia.

HealthyActions has reached over 4,300 learners, 75 percent of whom are female, in six counties across Liberia. Over half of female participants have received family planning counseling and have chosen a modern contraceptive method after completing the program—far above the 20 percent contraceptive prevalence rate for Liberia. Here’s how.

Lessons from fighting HIV to fend off next wave of epidemics

The AIDS epidemic is relatively young. It was only 30 years ago this year that scientists first discovered HIV, the virus that causes AIDS. Perhaps it’s because it’s relatively young that efforts to abate it could learn from history and adopt new approaches.

Now, according to the UN Development Programme (UNDP), it’s time to “Use lessons from fighting HIV to fend off new regional threats in Asia.” From their statement:

“The effective approaches to HIV in Asia and the Pacific have illustrated that a focus on law and human rights, and attention to the needs of marginalized people, can support the achievement of human development objectives,” says Clifton Cortez, UNDP’s HIV, Health and Development Team Leader in Bangkok. “We think the same lessons can be applied to reducing the threat posed by chronic non-communicable diseases that will have catastrophic human and financial impacts in this region,” he says.

Uganda to Increase HIV/AIDS Spending

Some good news out of Uganda. The government announced that it will double the amount of money it spends on life-saving anti-retroviral drugs (ARVs). It’s hope is to reduce the spread of HIV throughout the country.

The bottom line is that 1.3 million Ugandans will have access to free ARVs over the next year. That is a big jump from the 600,000 currently receiving treatment.

AFP reported on how the country is coming back after falling behind on the battle against HIV/AIDS.

Uganda was once heralded as a success story in the fight against HIV, with President Yoweri Museveni being among the first African leaders to speak openly about AIDS and the government mounting a highly successful public awareness campaign in the late 1980s and 1990s.

Infection rates initially dropped from double to single digits, but according to the most recent statistics, from 2011, the national prevalence rate rose to 7.3 percent from 6.4 percent in 2004-05 — with health officials blaming increased complacency.

“We want to make HIV not a health problem anymore,” the doctor said, explaining the drive would target those who have a low CD4 cell count — or the type of cells that fight infection — as well as the groups most at risk, such as sex workers, truckers and fishing communities.

“If we identify those who are positive early, put them on treatment early, we are going to reduce the community viral load. Once we reduce the community viral load, the rate of transmission in the community is going to come down to very low levels,” Ario explained.

The new policy is expected to cost about 120 million dollars (90 million euros) per year, Ario said, with donors being asked to pick up much of the bill.

HIV/AIDS Fight Needs Innovative Financing Model

More sustained financing is needed to continue global progress against HIV/AIDS. Given the current challenges to global health financing, new solutions are vital to changing the current rate of progress.

“There is a moral obligation to maintain treatment for those who need it, and considerable resources have been implicitly pre-committed to lifelong HIV treatment and care,” say the authors of a recent paper published in the PLoS Medicine journal.


More money also needs to be better spent, they argue. HIV work must be linked to health systems strengthening, a move that will both increase the reach of HIV work and support the underlying health problems that contribute to the problem.

Financing the HIV response must also be achieved without damaging investments in health systems more broadly and other development sectors that are essential for social welfare (in turn addressing a number of the barriers to scaling up the HIV response). An HIV programme may have important external benefits for sexual and reproductive health; maternal and child health; or provide the necessary health system platforms for managing chronic conditions. Similarly, investments in strengthening health systems or addressing related co-morbidities that compound HIV vulnerability or worsen treatment outcomes are critically important to individuals living with HIV. Although core HIV interventions have been demonstrated to be cost-effective, total HIV spending in sub-Saharan African countries was an estimated 19.4% of total health spending in 2007 (range: 0.7%–64.4%). This amount exceeds the relative burden of HIV disability-adjusted life years and is at least partly due to the relatively high costs of HIV treatment compared to treatment for other prevalent diseases. There remains a difference between the amount spent on the HIV response across countries with a similar GDP per capita and HIV prevalence, and more work is required to understand the optimal level of domestic resourcing for HIV, given competing health sector priorities.

There are examples of innovative financing schemes, but they face challenges. The authors recognize that overtaxing and a hyper-focus on HIV/AIDS can do more harm than good. A careful approach that applies lessons learned can ensure changes are effective.

Innovative revenue streams are currently being explored in several countries. These schemes can generate significant funds, as seen in Zimbabwe with the 3% AIDS levy deducted from businesses and formal sector workers’ salaries since 2000 [7]. Other options, such as increased “sin taxes” on alcohol, could generate a “double dividend” by simultaneously increasing revenues and decreasing HIV-related risk behaviours [20]. The development of social health insurance could help attract further household resources and may be an important new source of financing in middle-income countries as development assistance scales down

Read the full research paper here.

It Takes a Market to get Men to Use Condoms in Africa. Here’s How.

What can be done to increase the use of condoms by men in African countries? PSI and the United Nations Population Fund (UNFPA) teamed up over the past year to study and report on the state of play in six African countries. The results are out in six new case studies that will be presented during a  consultative meeting on the Total Market Approach that PSI and UNFPA are hosting, today and tomorrow.

During the meeting, participants will discuss the findings from the six case studies conducted in African countries. Then, representatives from ten organizations will discuss how they can work together to support the development and implementation of the Total Market Approach in national markets for male condoms and other family planning supplies.

The UNFPA sponsored case studies were carried out in the past 12 months with support from two independent researchers in Botswana, Lesotho, Mali, South Africa, Swaziland, and Uganda. All of the countries have large condom social marketing programs, are affected by HIV, and have high maternal morbidity and mortality relative to their economic development.

Content for the case studies was based on a review of the literature, seven key TMA metrics calculated from national-level data, and interviews with stakeholders. All case studies were subject to review by stakeholders, including Ministries of Health and non-governmental organizations in all six countries, UNFPA’s local and regional offices, UNFPA headquarters in New York City, PSI country and regional offices, and PSI’s headquarters in Washington DC.

Each case study describe the market for male condoms in each of the countries, and the roles of the public, social marketing, and commercial sectors in those markets.

The cases illustrate the universe of need for condoms, levels of use, socioeconomic equity among users, and the market presence of condoms for reproductive health and HIV prevention (dual protection).

They also propose a set of recommendations for improving the effectiveness, efficiency, and sustainability of condom markets.

The studies aim to inform the development of appropriate, evidence-based decisions to increase condom use equitably and sustainably through actions undertaken in the public, socially marketed, and commercial sectors.

Real Voices: How Microbicides can reduce HIV Infections in Women

This is the third video of the Real Voices series from the International Partnership for Microbicides (IPM). The video highlights clinic researchers and outreach workers offering their reflections on the challenges women in their communities face and their hopes for the future.

IPM and its research partners hope to continue to develop promising new health tools for women, including a monthly vaginal microbicide ring to prevent HIV, now in Phase III trials, and a 60-day dual-purpose ring to prevent HIV and unintended pregnancy in pre-clinical development.

“It is our hope that these products, along with other technologies being developed across the field, will one day soon benefit women, families and communities around the world,” says the IPM.

Real Voices is an IPM video series featuring interviews with scientists, clinicians, advocates and community members, who share their views about the need for microbicides women can use to reduce their risk of HIV infection.