What Male Circumcision Taught Us About the Future of Funding for Global Health

By Karl Hofmann, President and CEO, PSI

Private capital is needed to test and develop proof that existing health solutions can be adapted to a developing world context. Once this proof is established, the solution has the power to unlock the large-scale government funding needed to dramatically improve health across the developing world.

As demonstrated in a new report released this week by PSI’s Impact magazine and Devex, in partnership with Fenton Communications, the landscape for global health financing has changed dramatically. High-income governments that provide foreign aid for health have steadily increased their support over the last decade. That support is now leveling or shrinking due to budget constraints. Governments are under increased pressure to reduce risk and ensure that all public funds for foreign aid are invested in solutions that guarantee results.

As a result, corporations, foundations and philanthropists are now taking an active role to help protect the progress already made against serious threats to health and economies like HIV, malaria, tuberculosis, pneumonia, and lack of access to family planning, which remain as urgent as ever. They are providing private capital to fund the type of innovation that governments cannot afford to advance on their own.

How We are Preventing Cervical Cancer in Kenya and Zimbabwe

By: Alexandra Steverson, Program Assistant for the Southern Africa Region*

Globally, one woman dies every two minutes from cervical cancer. As the second most common cancer among women, there are 530,000 new cases every year. The developing world is disproportionately burdened by this disease - 86% of cases occur in developing countries where prevention services are limited or unavailable. In some environments, the mortality rate is as high as 52%.

We know that infection with one of many strains of the Human Papillomavirus (HPV) is a leading cause of cervical cancer. The good news is that it can be prevented. Screening and treatment of pre-cancerous lesions is the most cost effective method of preventing the disease and creating positive health impact in low-resource settings. However, less than 5% of women in developing countries have accessed screening services. With simple, low-cost interventions, organization like PSI can improve health outcomes for a population that is often neglected, women around the world.

A New Chapter in Tuberculosis Diagnostics

By Petra Stankard, HIV/TB Technical Advisor at PSI

In 1882, Robert Koch discovered the bacteria that caused tuberculosis (TB) and introduced sputum smear microscopy as a method for diagnosing the disease. It was a major scientific advancement. Thousands of scientific advances have followed—we’ve walked on the moon, eradicated smallpox and discovered the makeup of an atom. But until recently, in laboratories throughout the developing world, the diagnosis of tuberculosis remained firmly rooted in Koch’s discovery.

Unfortunately, smear microscopy is far from a flawless diagnostic tool. Time-consuming and cumbersome, smear microscopy often fails to detect TB in people living with HIV (one of the populations most at risk for TB disease) limiting efforts to prevent unnecessary deaths. Added to that, microscopy cannot identify whether the TB bacilli present in a smear are drug resistant. This consequently slows diagnosis and treatment of multi-drug resistant TB even as it becomes a growing health problem.

Inside the 2012 Impact Awards

During last week’s International AIDS Conference, PSI held its 2012 Impact Awards. HRH Crown Princess Mette-Marit of Norway and Actress/PSI Ambassador Debra Messing co-hosted the event at the Corcoran Gallery of Art. The focus of the event was to honor individuals who have made a lasting impact on the fight against AIDS.

The event also marked the recent release of our latest issue of Impact Magazine.  This quarter the focus is squarely upon HIV/AIDS by discussing the combined approach to HIV and AIDS. The issue presents interviews with leading HIV thought leaders and implementers, as well as personal stories from men and women living with HIV. Interviews include Impact Award winner Ron Zwanziger, Senator John Boozman (R-AR), Representative Jim McDermott (D-WA), Representative Barbara Lee (D-CA), Dr. Daniel Halperin and Craig Timberg, authors of the new book “Tinderbox: How the West Sparked the AIDS Epidemic and How the World Can Finally Overcome It,” and PSI technical experts.

“Turning the tide is only possible if we devote our minds, resources and support—collectively—to the global AIDS response,” said Messing. “This year’s Impact Awards celebrate a distinguished group of men and women who have helped make progress possible.”

A bit more about the winners:

Zimbabwean Parliamentarians lead by example in promoting male circumcision

On June 22, 2012, a group of three Members of Parliament (MPs) chatted quietly among themselves as they waited to get circumcised outside a make shift clinic set up at the Parliament building. They were the first of the 35 Zimbabwean legislators who were circumcised as part of the “Parliamentarians making the Smart Choice” campaign implemented by PSI in collaboration with the Ministry of Health and Child Welfare (MOHCW) and The National AIDS Council (NAC) for the Zimbabwe Parliamentarians against HIV (ZIPAH), a voluntary organisation made up of Parliamentarians. A total of 120 MPs were also counselled and tested for HIV during the campaign.

The ZIPAH chairman, Blessing Chebundo was the first to be circumcised having worked closely with PSI to motivate other MPs to get circumcised.  Blessing grew up in the small village of Shurugwi, 330 kilometres from the capital city of Harare.  Growing up, Blessing always had the ability to lead others.  In high school, he was appointed the head boy, and later became leader of a labour union.   He admits that the leadership skills gained during his early years at school, in church and later as a politician helped him to inspire his fellow legislators to lead by example by getting circumcised.

“I remember first hearing about male circumcision during a workshop conducted by PSI for community leaders in 2009. PSI explained the effectiveness of male circumcision in preventing HIV and urged leaders to talk about the new prevention strategy in their communities.  Later, messages on male circumcision began appearing everywhere on various media channels so that it was quite difficult to ignore them.”

70,000 Men Circumcised in Zimbabwe Since 2009 Campaign Launch

New Zimbabwe covers the successful program to circumcise men in Zimbabwe. The collaborative effort between PSI and Zimbabwe has reached 70,000 men since the programs inception in 2009.

Zimbabwe has 1.1 million people living with HIV, including 150,000 children, according to the National AIDS Council. But the country has made significant gains in fighting HIV, which infected 14 percent of the population in 2009, down from 23 percent in 2003, according to the United Nations.

Circumcision is said to help reduce the risk of contracting HIV and the Zimbabwe campaign is targeting to have 1.2 million boys and men circumcised by 2015.

“Our main challenge now is demand creation, getting word to local communities encouraging more people to be circumcised. Local leadership that includes chiefs has to be involved and we are hoping that MPs will take the message to them,” Hatzold said.

PSI/Zimbabwe’s Farai Chieza Speaks Out on Safe Water

Farai Chieza, from PSI/Zimbabwe, closes out the World Water Day 2012 reception with the US Senate by speaking about a caregiver he’s come to know in Zimbabwe. Earlier in the day, Farai participated in a round table discussion on diarrheal diseases and then conducted top priority Congressional meetings. Watch the video above to hear about the impact of unsafe water on the lives of women and families living in Zimbabwe.

PSI and Gates Collaborate to Test Male Circumcision Innovation in Zimbabwe

This week, the New York Times reported on the development of two male circumcision devices: PrePex and Shang Ring. Both are exciting innovations that make it quicker, easier and safer to perform circumcisions on men.

Now that three studies have shown that circumcising adult heterosexual men is one of the most effective “vaccines” against AIDS — reducing the chances of infection by 60 percent or more — public health experts are struggling to find ways to make the process faster, cheaper and safer.

The goal is to circumcise 20 million African men by 2015, but only about 600,000 have had the operation thus far. Even a skilled surgeon takes about 15 minutes, most African countries are desperately short of surgeons, and there is no Mohels Without Borders.

So donors are pinning their hopes on several devices now being tested to speed things up.

Dr. Stefano Bertozzi, director of H.I.V. for the Bill and Melinda Gates Foundation, said it had its eyes on two, named PrePex and the Shang Ring, and was supporting efforts by the World Health Organization to evaluate them.

Visualizing Global Child Mortality Trends

Data on child mortality from UNICEF and visualized by The Economist is as equally promising as it is worrisome. In 40 years, Turkey has reduced its mortality rate from 200 deaths of children under the age of 5 per 1,000 live births to 25 deaths per 1,000 live births. That is a monumental step forward in ensuring that children are given the opportunity to thrive and live full, healthy lives.

The Circumcision Song!

If all goes according to plan, gentlemen across Sub-Saharan Africa will get that procedure they’ve been thinking about after they hear this tune by a trio of African pop stars.

The song was launched at the International Conference on AIDS and Sexually Transmitted Infections in Africa (ICASA) in Addis Ababa at a reception lead by former president of Botswana Festus Mogae and important donors and stakeholders who support the Voluntary Medical Male Circumcision as an effective way to help stem the transmission of HIV.  The catchy song features a trio of famous musicians from Africa, including Oliver Mtukudzi and Winky Dee of Zimbabwe and Vee from Botswana.

The production and recording of the song in Zimbabwe (including the choice of the lyrics) was coordinated by PSI/Zimbabwe and the Champions in Botswana. Special thanks to Kumbirai Chatora from PSI for couching the musicians in Zimbabwe. The production and recording of the song was funded by the Gates Foundation.

We are told that an audience of 200 suits at the conference could not stay seated and danced away during the premier of the song. And why not? “You know you are a champion/Get circumcised!”