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A Reflection on the Human Spirit on International Human Rights Day

Jonathan Hale is deputy assistant administrator for Europe and Eurasia. Photo Credit: USAID.

The 20th century was marked by dark episodes of violence, repression and mass killing around world especially in Europe. Hitler killed between 11 to 14 million Jews and other minorities, and Stalin was responsible for the death of more than 20 million Soviet citizens. The exact numbers may never be known and the depth of individual suffering is also incomprehensible. Beyond what happened in wars, regimes themselves were responsible for massive human rights violations against their own people.  Rule by fear was the order of the day.

On this 2012 International Human Rights Day, the final day of our 16 Days of Activism Against Gender Violence, the countries of the former Soviet Union and Eastern Europe continue to deal with the legacy of that history and continue to come to terms with it. Over the last several years, I have spoken with many USAID Foreign Service Nationals who have told me their stories of what happened to their grandparents or their parents or in some cases in Bosnia harrowing stories of their own families’ ordeals. They pointed out that 20 years ago we never would have been able to have such a conversation.  Sadly, at the same time there are still far too many reports of human rights abuses in the region – of those who speak out against corruption, who speak up for their rights and whose political views still sometimes face peril – incarceration, beatings, or even death.

Mass grave in Guba, Azerbaijan - alleged victims of mass killings of Azerbaijani, Jewish, Lezgi by Bolsheviks in March 1918. Photo Credit: Jonathan Hale.

During the darkest times of the Soviet period, people still found a way to express dissent whether openly or through literature, art, and music. The same is true today – people will not be silenced, the human spirit is too strong. This morning I met activists from Belarus to discuss ongoing challenges. In Belarus, the government arbitrarily arrests and imprisons citizens for criticizing officials, for participating in demonstrations and for other political reasons. There are hundreds of politically motivated imprisonments and no accountability for past politically motivated disappearances. And yet brave Belarusians like those I just met continue to seek a way to press for protection of their rights and to improve the lives of their families.

A cadre of human rights activists across the former Soviet Union who devote their lives to bringing human rights protections to every individual remain active. As the Belorussian activists expressed concerns about the conditions of confinement of fellow activists in Belarus, it was clear that even today this is still a perilous endeavor to demand protections for the most fundamental rights. We admire the efforts of these individuals and are reminded of the special place that the U.S. possess in the hearts and minds of the human rights defenders from around the world.

The American people have long stood with repressed people in Europe and Eurasia and around the world. In the 21st Century, we will continue to support those who speak out for universal human rights, freedom and dignity.

Book Review: “No Time to Lose: A Life in Pursuit of Deadly Viruses” by Peter Piot; Reviewed by Jennifer Albertini, USAID Africa

Jennifer (Jenny) Albertini is Senior HIV/AIDS Technical Advisor for USAID Africa's Health Team where she focuses on policy, program and technical guidance for the Agency's HIV/AIDS programs in Africa. Jenny has worked with PEPFAR since its inception, including spending seven years in Zambia and Swaziland implementing and managing HIV/AIDS programs there.

Synopsis

For many, childhood is a time of wonder and ambitious dreams to travel to foreign lands and work on issues of social justice.

Often times, such dreams remain unfulfilled – but, not for Peter Piot. As he details in “No Time to Lose: A Life in Pursuit of Deadly Viruses,” more than half of Piot’s life has been spent chasing viruses and politicians around the globe in his effort to understand and mitigate the impact and devastation of infectious diseases.

What started as a mysterious virus delivered to his laboratory in Belgium in 1976 led to his first trip to Africa to pursue what later became known as Ebola. Before he knew it, Piot was partnering with scientists in Africa to investigate other infectious diseases, including sexually transmitted infections, positioning him well for when AIDS began chipping away at the continent in the early 1980’s. He was at the forefront of efforts to unravel what quickly became the newest and fastest growing pandemic. Translating his scientific prowess into bureaucratic-ease, a decade later, Piot helped bring together 10 United Nations agencies to form UNAIDS, the Joint United Nations Programme on HIV/AIDS. UNAIDS was the first UN agency dedicated solely to working on fighting one disease. He led the agency for 14 years (1994-2008).

No Time to Lose…” isn’t just about the laboratories and boardrooms that Piot was able to grace during his career. As he describes, his relationship with truck drivers and heads of state, physicians and patients, and commercial sex workers and advocates is what pushed him to keep fighting, learning, fundraising, and advocating for those affected with infectious diseases for more than thirty years. These relationships still drive him, and this book is as much a reflection of his career in global health as it is an expression of his respect for the people who have been most affected around the world.

Review

Piot’s book is not just a clinical review of infectious diseases – in fact, in the context of his narrative, Ebola or HIV & AIDS could have gone by any other name. What matters – and where Piot devotes much of his prose – is the impact that these diseases have had on the fabric of societies, and how the themes of poverty, family and governance radiate throughout all of their (and our) lives. He was able to connect the science uncovered in the laboratories with the faces of the patients he saw in clinics from Brussels to Kinshasa – and throughout the world. Perhaps most importantly, his book brings these stories to the world leaders he lobbied for so many years to do more to advance efforts to fight HIV & AIDS in their countries. He was not always successful at moving them towards action, but he always tried. And, his persistence is palpable through the pages.

I first saw Peter Piot in a nightclub in Rio during the International AIDS Society conference of 2005. As a self-proclaimed “public health nerd,” it was practically a celebrity sighting to see such an esteemed man dancing with the rest of us mere mortals. The results of a successful male circumcision trial in South Africa had been released that day and there was buzz in the air about this highly efficacious prevention intervention. It felt good to take a deep breath and celebrate a win for once.

One of my favorite quotes from Piot, as he describes AIDS, is, “This time, I knew, we were looking at the worst epidemic I could imagine, the greatest assailant I would ever face, something that would absorb all the energy that I could throw at it, and far more. In my mother tongue, Dutch, I wrote in my notebook:  Incredible. A catastrophe for Africa. This is what I want to work on. It will change everything.”

A lot of progress has been made since that catastrophe first started 30 years ago. We are now – hopefully – on a path towards creating an AIDS-free generation. As we commemorate World AIDS Day this year, a review of Piot’s book seems most timely. It allows us to reflect on where we have been and how far we have come, but it also serves as an impetus to keep moving towards our goal with a sense that there is ‘no time to lose.’

Discussion Questions

  1. Although Piot lobbied South African President Mbeki repeatedly to change his way of addressing HIV/AIDS in his country, years went by before real change happened as the epidemic grew worse. Was there anything Piot could have done differently to have moved Mbeki into action earlier?
  2. Certain African leaders (like Festus Mogae of Botswana) have been outspoken champions on HIV/AIDS. What are the characteristics or drivers which have made them positive leaders and what would it take for more of their peers to also take on these efforts?
  3. Did the creation of UNAIDS serve (one of) its intended purpose of focusing UN efforts around a single disease to achieve maximum impact, or would they have made more of an impact utilizing their existing platforms?
  4. Several recent articles have focused on balancing career and family, like Anne-Marie Slaughter’s piece “Why Women Still Can’t Have It all.” Piot mentions his family rarely in this book, although the birth of his children coincided with the beginning of the initial Ebola and AIDS outbreaks and he speaks volumes about his incessant travelling, late nights at work, etc. What are the differences that would have been experienced by a woman taking on Piot’s role at the time he worked on these issues?  What, if anything, would be different now?

Book Review: “Tinderbox” by Daniel Halperin & Craig Timberg; Reviewed by Roxana Rogers, Paul Mahanna, David Stanton, Office of HIV/AIDS

Roxana Rogers, Director of the Office of HIV/AIDS, has a lifetime of experience working for USAID, previously supporting health offices in Zimbabwe and Burkina Faso. She has also worked as the Health & PEPFAR Office Chief at the USAID mission in South Africa.

Synopsis

Daniel Halperin, a medical anthropologist with a peripatetic background, including work with USAID, and Craig Timberg, a Washington Post journalist, combined impressive talent in this book, which details the unintended consequences of colonialization as it created the ideal situation for an explosive AIDS epidemic.

For centuries, or even millennia, SIV (simian immunodeficiency virus) had been carried by monkeys, and probably jumped from monkey to man many times as men killed and cut up monkeys to eat as bush meat. But, until the time of colonial ransacking, the virus fell on wet moss, infecting households occasionally but travelling no further. The brutal intrusion of colonial Europeans seeking fast wealth and power destroyed ancient social norms, tore apart families and created a “tinderbox” ignited by the spark that turned into a raging epidemic.

The authors provocatively argue that Westerners, and even USAID, have failed to appreciate the unique risk factors in this tinderbox. HIV spreads in very different ways in different parts of the world, yet we used (and still tend to use) the same approach to fighting the epidemic everywhere. While acknowledging the importance of treatment and other interventions, the book argues that in Africa the major intervention for HIV should be prevention aimed directly at the main cause of its spread: sexual behavior. They also argue that local solutions work best.

Review

We found this a fascinating, very readable book that draws on science, social history, anthropology and personal stories to tell the evolution of the disease and recommend solutions.

The book traces HIV’s spread over the last century, starting from chimpanzees in isolated West African rainforests to the boomtown, Leopoldville, and from there to the rest of Africa and the world. It tells the unlikely story of how an American Rhodes scholar who had bicycled across Africa, paired up with a venerable evolutionary British biologist and traced the genetic history of the virus by analyzing samples of blood and tissues that had remarkably been preserved for 40 or 50 years. And, how Californian scientists studied monkey feces in remote sections of Cameroon to determine the exact area where the virus leaped from monkey to man.

It tells compelling stories about Africans infected early, before drugs were available, struggling to warn people to change behavior despite the stigma associated with AIDS; people like the famous Zairian singer Franco, who died in 1989; and, the popular Ugandan singer Philly Lutaaya who spent his last days singing messages of prevention and hope. And, how President Museveni in the earlier days of his presidency, recognized the threat posed by HIV and preached “zero grazing.”  Under the influence of this early leadership, behavior changed dramatically in Uganda and prevalence fell rapidly.

The authors also take aim with certain aspects of the U.S. Government’s President’s Emergency Plan for AIDS Relief (PEPFAR), which they say has taken an approach to fighting HIV that is expensive, not adapted or locally designed, and too dependent on technology. In its initial days, they say PEPFAR was too focused on A, for ‘abstinence’ when the focus should have been on B, for ‘be faithful’ – also known as partner reduction. They point out that condoms have a role to play where key populations – such as gay populations and sex workers – drive the epidemic, but not where the epidemic is generalized and affects all populations indiscriminately. USAID promoted condoms as one key strategy to fighting AIDS because they played a significant role in driving down the epidemic in the U.S., and because they were easy to count and report as indicators, claim the authors. Dr. Halperin, who was an outspoken advocate of circumcision to prevent HIV long before the World Health Organization (WHO) had endorsed it based on the outcome of three clinical trials, laments that had we promoted circumcision years earlier, much transmission would have been prevented.

Today, the United States is looking to eliminate AIDS as a disease of consequence. The tipping point, when the infection rate falls below the rate of new people on treatment, is in sight. In November, one year ago, Secretary of State Hillary Clinton announced that the U.S. Government is on the road to an AIDS-Free generation; then on World AIDS Day last year, President Obama announced that the United States, through PEFPAR, would scale up treatment, circumcision and prevention of mother to child transmission interventions, with the dual goal of saving lives and preventing new infections.

The contributions of the United States to fighting HIV & AIDS and improving health in Africa have been outstanding. Indeed, it is now hard to remember what Southern and Eastern Africa looked in 2003. AIDS affected every aspect of life. Hospitals were overwhelmed. I remember visiting a hospital where two people shared the same bed and a third laid on the floor. Coffin-making was a growing business and funerals were almost a daily event. This has turned around dramatically, with much credit to PEPFAR and USAID. Almost 8 million in the world are receiving treatment, and more than half of those receive some support from PEPFAR.

Indeed through PEPFAR, USAID has changed the world. Some coffin makers are going out of business. Yet, it would be a mistake to ignore the lessons from this book. We know that sustaining the response will be challenging over the long term. The findings of many studies confirm what we already know — that adherence is a challenge. Risk perception is low. Uganda, the early success story, is now experiencing an increase in prevalence as the commitment of local leadership has waned. Unless there is fundamental behavior change that accompanies the scaled up efforts around treatment, our remarkable success to date may be short lived.

Discussion Questions

  1. The authors present some unorthodox views on the long-term approaches to ending the AIDS epidemic. To what extent do you agree or disagree with their case for “how the world can finally overcome AIDS”?
  2. A number of countries are now experiencing declines in HIV prevalence. What, if any, are the roles of interventions that address changes in behavior as other more aggressive interventions, such as treatment for prevention and circumcision, are rapidly being scaled up in Africa?
  3. The AIDS epidemic in Africa is a tragic example of the negative consequences of both colonialization of Africa and the increased mobility and inequity that accompanied economic development. But, was it inevitable?  What are the lessons learned from the history of HIV in Africa and around the world?
  4. The book outlines the importance of local leadership in affecting social change. If this is true, what is the role of an international development agency in affecting sustainable long-term change?
  5. What most surprised you in the book?  Has your view of the HIV epidemic changed after reading this book and how?

Implementation Science in Action: Turning HIV Research Into an AIDS-free Reality

I began work in USAID’s Office of HIV/AIDS this past August – and, what an exciting time it’s been! With the agency-wide shift towards program efficiency, capacity building, country ownership and sustainability, a new term has risen to prominence: implementation science.

The implementation science framework aims to increase the sustainability, cost-effectiveness and impact of global health programs in areas hardest hit by HIV & AIDS. It translates and implements research findings into routine and common practice. As we come together this week to commemorate World AIDS Day 2012, it’s important to remember the vital role and impact implementation science has in helping us achieve an AIDS-free generation.

In August 2011, USAID announced the Annual Program Statement (APS), “Implementation Science Research to Support Programs under PEPFAR.” Under the first round of the APS, USAID and PEPFAR awarded more than $21 million for eight studies in eight countries. I’ve had the privilege to provide support to each of these eight studies. While implementation has only just begun, I am confident that the impact of these studies will be powerful.

These eight studies will answer critical questions such as:

  • How can we shorten the time between an HIV positive diagnosis and entry into care?
  • What are the most cost effective and feasible measures to significantly reduce MTCT?
  • How do we translate the high efficacy of antiretroviral-based prevention found in clinical trials to programmatic delivery?

Hopefully, by now, you are as excited about implementation science as I am, because this is your chance to channel your excitement into action! The second round of the APS “Implementation Science Research to Support Programs under PEPFAR” is underway. The APS solicitation is public and the deadline for concept paper submissions is January 31, 2013.  USAID anticipates awarding up to 10 awards, with maximum funding available for a single application set at $1.8 million over three years.

The scope of the APS provides a unique opportunity to fund cutting-edge research in HIV-specific program areas, improving the integration of programs across the prevention, care and treatment continuum.  Data gathered will support efforts to prevent new infections and save lives.

Have a great idea? Apply! Know a local organization with research capacity expertise? Share the solicitation!  I’m excited for the innovative ideas that will be evaluated in Round 2!

Shared Responsibility: The Catalyst for Long-Term Success in HIV & AIDS

Ariel Pablos-Mendez is the Assistant Administrator for Global Health

This post originally appeared on AIDS.gov.

This is a remarkable time to be in Global Health. The successes we are seeing now would not have been achieved without the shared responsibility and partnerships that have been forged over the years – most important of which are those with our implementing partners. Our implementing partners – in collaboration with civil society, the private sector, communities of faith, host governments, NGOs and many others local institutions – have been at the forefront of and catalyst for these shifts and transitions. And as we near World AIDS Day, we celebrate this collective effort as we get closer and closer to an AIDS-free generation.

But to make an AIDS-free generation a reality, we must continue to come together inclusively – understanding our strengths, contributions and the roles we each play in the response. This is about each player owning their part and sharing in the responsibility of reaching this goal– one that requires partnerships and long-term commitments, including collaborations with organizations like the Global Fund Against AIDS, TB & Malaria.

The U.S. is the largest contributor to the Global Fund, investing to date over $7 billion. USAID, through PEPFAR, works directly with the Global Fund by helping with grant oversight and implementation, managing the PEPFAR emergency commodity fund that works to respond to stock-out of drugs and other essential HIV & AIDS medicines and supplies, and working with Global Fund stakeholders to leverage resources in country. PEPFAR and the Global Fund are highly interdependent in supporting countries. Since 2011, the two have supported over 70 percent of all persons on treatment in developing countries worldwide.

Sharing responsibility through partnerships and inclusivity are particularly important for host nations as they move up the economic ladder. Many developing countries around the world are seeing unprecedented growth of their GDP, and half the low-income countries in 2000 will be middle income by 2020.  A growing number of our partner countries will reach total health spending levels per capita that enables them to cover basic health services for the first time in history.  This is a great success in international development and the tax-payers who make it possible deserve credit for this accomplishment.

This transformation is what I refer to as the ‘economic transition of health’. It is critical that efficient and equitable health systems be in place as this transition occurs. Otherwise, the poor may still not have access to quality services and others may be thrown back into poverty by catastrophic health expenditures. This could have significant negative effects on the work we do in HIV & AIDS and under PEPFAR. It could reverse many years of progress, and squash future gains for an AIDS-free generation, an end to preventable child death and maternal mortality. The time to create equitable and sustainable health systems is now.

Last week, I had the privilege of addressing over 42 of USAID’s PEPFAR implementing partner projects at our annual Partner’s Meeting. We talked about transitions in HIV & AIDS at the country level and the challenges and opportunities we face. The most purposeful transitions we are witnessing today is the shift from a U.S. Government to a country-led approach, from direct service delivery to technical assistance models, and from an emergency response to country-led and country-owned HIV & AIDS programs.

Countries want to step up, are proud of their HIV & AIDS programs and want results. Intensive conversations are being initiated and program reviews are being implemented, in particular around anti-retroviral treatment and preventing mother-to-child transmission. Tipping points are occurring in many countries, where the number of new HIV infections is lower than the number of deaths, marking the beginning of the end of AIDS. Shifts and transitions are happening at multiple levels and vary from country to country, and technical area to technical area, increasingly under the stewardship and growing financial support of national governments and local communities. Regardless of where a country or HIV & AIDS program is, our goal has been and will continue to be to move programs toward greater independence and sustainability.

We and our implementing partners have a tremendous opportunity to demonstrate our shared responsibility to making smart transitions and identifying strategic partnerships, while still meeting targets. It will require inclusive planning, growing local capacity and some patience. U.S. investments through PEPFAR have delivered extraordinary results. One year after President Obama announced aggressive targets, PEPFAR is on track to meet its goals. By working together at all these levels, we can foster functioning health systems with country ownership and sustainability, and reach our goal of an AIDS-free generation.

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Debra Messing, Actress and HIV Activist, Promotes HIV Combination Prevention in Zambia

This past May I traveled to Zambia and had the chance to see my taxpayer dollars hard at work – saving and improving lives.

I wanted to see, and learn, how “combination prevention” helps stop the spread of HIV. It’s actually pretty common sense stuff; when multiple interventions are used together, the likelihood of HIV transmission is greatly reduced.

One of my many honors in Zambia was launching a “New Start” counseling and testing center, funded by the U.S. government, with USAID Zambia Mission Director, Dr. Susan Brems, and representatives from the Zambian Ministry of Health.

Debra Messing, Actress and PSI Global Health Ambassador, cuts the ribbon at a US-funded New Start HIV counseling and testing center in Mongu, Zambia. Photo Credit: Zoeann Murphy

The New Start center is located in Mongu, a small, isolated town in Western Province. I was amazed to learn that this was the first center in the area that offered services like voluntary counseling and testing for HIV, male circumcision, STI diagnosis and reproductive health services — all under one roof.

There were nearly 200 people who came from all over the community to be at the launch event. It was a hot muggy day, but still, there were lots of singing and dancing and drama. It was truly a celebration.

Now, the New Start network has nine centers in seven provinces—and reaches more than 14,000 Zambians each month with much needed HIV services. This is incredible to me.

After I cut the ribbon at the New Start center, I had a chance to meet the counselors and nurses who will actually be providing HIV counseling and testing services to the community, and they absolutely beamed with pride. They were excited to walk me through each of the rooms in the clinic—only five in all. I could tell they really wanted me to see and understand what this clinic means to the people in their community.

Seeing their enthusiasm made me so proud to know that the Zambian Government and my government are working in partnership through USAID and PEPFAR, with local organizations like Society for Family Health (SFH), as well as private sector partners— so that residents of Western Province have access to the health services they need.

I now realize that if we are really going to see an AIDS-free generation, we have to work together.  It takes partnerships at all levels – from governments to grassroots to the private sector. Everyone has a role to play.

In Celebration of Men: Stepping up for Male Circumcision

Emmanuel Njeuhmeli serves as Senior Biomedical Prevention Advisor at the Office of HIV/AIDS.

On November 19, the first ever International Men’s Day was celebrated in over 60 countries around the world. It was an occasion to put the spotlight on men’s health, improving gender relations, and recognize positive male role models who make valuable contributions to family, community and society. This year, we recognize and celebrate the hundreds of thousands of men in East and Southern Africa who are stepping up for Voluntary Medical Male Circumcision (VMMC) to protect their own health and that of their families.

We also recognize the political, traditional and community leaders who are leading the charge in their countries and local communities. For many communities, male circumcision has cultural significance representing a rite of passage from childhood to manhood. Ministries of Health are working closely with traditional leaders to ensure that male circumcision is medically safe while still respecting the meaning of the tradition. In 2011, I participated in one such ceremony with the Changaani tribe at an “initiation camp” in a remote area of southern Zimbabwe where adolescent boys learn what it means to be a man. Despite the cultural challenges, the Zimbabwe Ministry of Health and Social Welfare (MOHSW) with support from PEPFAR and USAID, and in collaboration with traditional leaders, was able to provide these boys with safe male circumcision services.

In June 2012, I was again fortunate to witness the kind of male leadership we celebrated on Nov. 19. Mr. Blessing Chebundo, Chairman of Zimbabwe Parliamentarians against AIDS, and a group of fellow Zimbabwe parliamentarians, underwent voluntary medical male circumcision to inspire other men in their country to follow suit. Zimbabwe aims to circumcise 1.2 million men aged 13 to 29 years by 2015 with the potential impact of preventing 750,000 new HIV infections.  It will take leading by example, as demonstrated by Mr. Chebundo, to get this done.

USAID and UNAIDS have estimated that VMMC has the potential to avert more than 3.4 million new HIV infections in 14 countries in Eastern and Southern Africa, and save an estimated $16.5 billion in care and treatment over the next  15 years, freeing up resources for other crucial HIV interventions. It also offers a unique opportunity to not only prevent HIV, but improve men’s overall health. VMMC services present an opportunity to engage men who might otherwise never interact with the health system.

While women are likely to learn their HIV status during prenatal visits, there are simply no comparable programs for reaching men. VMMC programs have the potential to offer millions of men the opportunity to learn their HIV status, along with counseling, condom provision, services around sexually transmitted infections, and the rare chance to discuss their reproductive health.

USAID, with PEPFAR funding, is committed to supporting countries in Eastern and Southern Africa to pave the path for an HIV-Free generation by accelerating scale up of VMMC over the next five years. As we work together to roll out this powerful, life-saving intervention in these 14 countries, let us remember the more than 2 million men who have already made the brave decision to step up and protect their health, their family and their communities by getting circumcised.

I wish all of you brave men a very happy International Men’s Day!

16 Day Challenge: Let’s Eliminate Gender Violence

Carla Koppell serves as Senior Coordinator for Gender Equality and Women’s Empowerment at USAID

Today we launch our 16 Days of Activism Against Gender Violence.

One young rape survivor in a camp for the internally displaced in Goma, a city in the eastern Democratic Republic of Congo (DRC), is one of the strongest people I have met since joining USAID as Senior Coordinator. She survived a vicious gang rape while collecting fuelwood in the surrounding forest. She only saw a doctor after receiving contributions to pay for treatment from fellow impoverished camp residents. She survives by selling dung briquettes—though she earns less than she did from fuelwood— because she is too afraid for her safety to go back to the forest for wood. She is still recovering.

Yet, she came to tell her painful story to me and other strangers. Why? Because she hopes that by talking with us, others might be kept safe. She is a victim and leader at the same time; she represents and speaks for millions of women and girls around the world who face abuse, discrimination and violence when they are beaten, married as children, circumcised, attacked with acid, or sold like cattle.

This week we launch the 16 Days of Activism for the Elimination of Gender Violence, which runs from November 25 to December 10. We must use this time to recognize the magnitude of the challenge. In the DRC, for example, a 2011 study in the American Journal of Public Health estimates that some 1,150 women are raped every day. And one USAID-supported study found that Bangladesh sacrifices over 2 percent of GDP annually as a result of gender-based violence (GBV). The health care and legal costs, lost income and lost productivity are enormous. Yet even as we contemplate the numbers, we must not forget the individuals, the victims of violence, as well as the incredible male and female leaders—some of whom are survivors—that lead the campaign to end the epidemic.

USAID has greatly increased our focus to combating gender-based violence. This need is front and center in the Agency’s new Gender Equality and Female Empowerment policy (PDF). Additionally this past summer, the United States released its first ever Strategy for Preventing and Responding to Gender-Based Violence Globally (PDF), which incorporates action plans for our Agency as well as the State Department. USAID followed-up with a vision for ending child marriage and meeting the needs of married youth. At the same time, the U.S. National Action Plan on Women, Peace and Security and accompanying USAID implementation plan include a more extensive focus on sexual violence in situations of state fragility triggered by conflict, humanitarian disaster, or political transition. USAID now truly has a comprehensive strategic vision and frame for addressing the many forms of GBV around the world.

While I am proud of the commitment implicit in the new policy frame, I am even more gratified to see expanded efforts on the ground. For example, a new commitment to combat child marriage was announced by our mission in Bangladesh in October; our mission in Pakistan incorporates GBV prevention efforts into education programs; our programs in the Democratic Republic of Congo have ramped up their focus on GBV prevention as part of several sector efforts; and in Afghanistan, USAID is focused on consolidating gains for women’s rights and opportunity. These efforts are emblematic of how our commitment to end gender violence is translating into action.

As our policies and strategies gain traction and implementation gains speed, we recognize a collective responsibility to ensure our mission translates into results around the world. I recognize a personal obligation to make sure that one woman’s story in the DRC was not told in vain.

Hope Springs in Burma for Maternal and Child Health

Ariel Pablos-Mendez is the Assistant Administrator for Global Health

With an economy of more than $80 billion, growing at over 5 percent annually, Burma presents unique challenges and opportunities for development as it transitions to an open society. Inequality, ethnic strife and migrants in border areas, as well as authoritarian vestiges of the military regime and crony capitalism, are some of the challenges. While women are relatively empowered thanks to low fertility, Buddhism underpins a rich culture, and a socialist past left reportedly high levels of literacy and very low crime rates.

Under the leadership and vision of President U. Thein Sein, his partners in government, and an energized Parliament that notably includes Daw Aung San Suu Kyi, the reform agenda moves forward.

This month, Robert Clay joined me on a visit to Burma – the first of its sort for global health. We were generously hosted by ThuVan Dinh, our new health advisor in Rangoon, and Dr. Aye Aye Thwin, the health office chief from the regional mission in Thailand, with great support from USAID Mission Director Chris Milligan and U.S. Ambassador to Burma Derek Mitchell.

Health statistics are mostly unreliable – the result of poor health information systems and no census since the late 1980s. Add regions in conflict, and a central bureaucracy and peripheral culture that demanded positive reports, challenges seem aplenty. But at least in Rangoon and nearby townships, things look better than in many low-income countries and are ripe for smart development. Hope springs anew for a transformative era of peace, prosperity and development for a country that’s just emerging from isolation from the international community.

We met the Minister of Health and officials in other ministries in Naypyitaw, the brand new capital city as well as with several other governmental institutions in Rangoon and nearby townships, and partners (implementing NGOs, U.N. agencies, bilateral donors, private sector organizations, etc.) Our calling card was the integrated and joint priority of reducing child mortality by 30 percent in five years. And while maternal and child health, HIV/AIDS, TB and malaria are obvious targets for investment, there was a strong emphasis on the importance of strengthening health systems and stemming the growing problem of chronic diseases and injuries: of the approximately 500,000 annual deaths, 40 percent are due to chronic conditions and 30 percent to injuries according to estimates.

Pablos-Mendez talks with health workers in Burma. Photo credit: Leek Deng.

New commitments in health hold promise for the Burmese people. Soon, health officials plan to roll out the pentavalent vaccine – a combination of five vaccines in one: diphtheria, tetanus, whooping cough, hepatitis B and Haemophilus influenza type b (the bacteria that causes meningitis, pneumonia and otitis) for children in the country under the age of 1. Leadership has pledged to hire as many midwives as needed, and efforts are underway with Parliament to raise a meager health budget.

Add possibilities of new U.S. investment in Burma’s first Demographic Health Survey, a public private partnership to increase neonatal survival by offering evidence-based training and high quality affordable resuscitation devices to birth attendants to Help Babies Breath, and technical assistance on financing reform towards Universal Health Care (UHC), there is great momentum and transitions afoot.

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Reflections on Burma

Reflective lakes, green mountains, golden pagodas, and friendly people.  These are some of the lasting images from my first visit to Burma, also known as Myanmar, this past month.  Clearly, Burma is a country on the move, making up for lost time when it was largely isolated from the rest of the world.  While there to determine how USAID could best work with the national government and the local partners on health priorities, people wanted to know about our “window to the world” at every stop.  Top requests—training and insights on how to improve the quality of information.  Despite Burma’s long isolation from the West, Rangoon was very developed much to my surprise, clearly showing its connection to the southeast “Tiger countries,” particularly their next door neighbor—Thailand.

Robert Clay and Ariel Pablos-Mendes, Assistant Administrator for Global Health, on their recent trip to Burma, also known as Myanmar Photo Credit: Leek Deng, USAID

But I had a nagging feeling this did not reflect the true Burma, so the next time I visit, I’d really like to see what is beyond the city.

With that said, it proved to be an incredibly productive trip.  I traveled with the Assistant Administrator for USAID’s Global Health Bureau, Dr. Ariel Pablos-Mendez, and we spent most of our time meeting with government officials, technical experts, local civil society organizations, and other donors to hear from them about their experiences and thoughts for continuing to move Burma forward.  It quickly became clear to me that there is a great need in health, but Burma also has the potential to use donor assistance to build their country programs.  Our visit to a local township hospital and private clinics pointed out the need to improve decentralization, especially decision-making and data quality.

A few highlights

A visit to the Shwedegon Pagoda after a long day of meetings ended being one of my favorite highlights of Rangoon.  Imagine a village of temples, crowded with people celebrating the Buddhist Festival of Lights holiday, and the amount of excitement filling the streets.  Truly an experience I will not soon forget.
We also spent a day in the new capital city, Naypyitaw, meeting with the Minister of Health and his staff.  They were very gracious with their time and it was clear that USAID already enjoyed a good partnership.  The capital is quite a contrast to Rangoon.  The government built it just 7 years ago for a much larger population than what exists today, for example 12 lane roads without many cars.  And the flight up and back from Rangoon gave us some idea of the lush landscape of the rural area.

Finally, my most impressionable moment came while looking out my hotel room window over a beautiful lake and political activist, Aung San Suu Kyi’s, house.  It is hard to believe she was held there under house arrest for almost 15 years.  The world must look quite different for her, as she works tirelessly to help shape democracy for her country.  My hope is that our assistance will help Burma have both a vibrant democracy and a healthy society.

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