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African Leaders Call for Scale up Voluntary Medical Male Circumcision in East and Southern Africa

Dr. Emmanuel Njeuhmeli is the Senior Biomedical Prevention Advisor with USAID and Co-Chair of PEPFAR’s Male Circumcision Technical Working Group.

Scientific advances in the treatment and prevention of HIV infection over the past years have created unprecedented optimism that the fight against the HIV/AIDS. Voluntary Medical Male Circumcision (VMMC) for HIV prevention is one such intervention that has enormous potential to alter the course of the epidemic.

Three clinical trials have definitively demonstrated that VMMC can reduce female to male transmission of HIV by approximately 60%.  This means that if brought to scale to achieve a coverage of 80% of adolescents and men, VMMC could prevent 3.4 million new HIV infections and save countries in East and Southern Africa US$16.5 billion in care and treatment costs between now and 2025.

With tens of thousands of people who work in the field of HIV in Washington, D.C. —political leaders, public health experts, activists, people living with HIV—all equally committed to achieving a future free of AIDS, the time is now to examine possibilities to rapidly scale up comprehensive VMMC services. Key African political and traditional leaders from some of the hardest hit countries of East and Southern Africa will participate in a satellite session tonight to discuss challenges and solutions to accelerating VMMC scale up in 14 priority countries.

These leaders understand very well the urgency of bringing this intervention to scale.  Mr. Blessing Chebundo, a member of Zimbabwe’s Parliament, was publicly tested and circumcised last month in an amazing show of leadership. I was fortunate enough to be in Zimbabwe that day and witness 44 members of Parliament in a makeshift tent at Parliament House stepping up to inspire other men in their country to do their part for HIV prevention. It was a moment I will never forget.

We know that with strong leadership, commitment and coordination this is doable. We’ve seen Kenya’s successful VMMC program where more than 400,000 voluntary medical male circumcisions have been administered since 2008. Government leadership and program flexibility have been key.  In Iringa, Tanzania, local leaders and officials, with PEPFAR support, overcame human resource and infrastructure constraints and managed to exceed their targets, performing more than 100,000 VMMC since 2010. Thirty-one thousand circumcisions were performed during an eight-week campaign. Based on modeling estimates, they’ve already prevented over 14,000 new HIV infections. Surely other countries can do this too.

Preventable HIV infections occur every day among uncircumcised men in the countries of East and Southern Africa. Each day that this proven prevention method is not brought to scale represents a lost opportunity to change the course of the epidemic.

There is no time to waste, now, it’s time to act.

The Journey of Life for Children Living with HIV – From Diagnosis to Adulthood

Not long ago, it was expected that children living with HIV would not survive to adulthood.  Today, children living with HIV are thriving through adolescence into adulthood, and doing so in large numbers.

Though effective antiretroviral treatment is allowing many to live long and healthy lives, living with HIV remains a complex burden for these age groups. Treatment, care and support needs are challenging and ever-changing.  Focusing on clinical services alone is insufficient.  Children and adolescents living with HIV have a range of other essential needs that must be supported.  They require psychosocial support, sexual and reproductive health education, alcohol and substance use counseling, and information on voluntary and safe disclosure, loss, grief, and bereavement.   Children and adolescents are often confronted with a multitude of emotions, questions, and concerns regarding the complexities of disclosure, their health, and their future.

PEPFAR, WHO, UNICEF, national governments, NGOs, organizations of people living with HIV, and others are working to support children living with HIV as they transition from childhood to adolescence and adulthood.

One of USAID’s foremost concerns is how best to support and address the unique health, psychological, and social needs of adolescents living with HIV as they transition into adulthood and into adult care environments.  Only an estimated 15% of HIV-exposed infants are identified and in southern Africa less than 12% those between 15 and 24 years of age have been tested and know their HIV status results.   USAID acknowledges the urgent need for age-appropriate HIV testing and counseling for children and youth to identify those that remain undiagnosed. 

With the participation of children and adolescents living with HIV in USAID programs, we continue to better understand how best to reach adolescents with the services they need.   For one, HIV remains highly stigmatized.  Children and adolescents living with HIV are confronted with complex challenges regarding disclosure with their peers and even family members.   They are in need of support to practice voluntary and safe disclosure, maintain treatment literacy and adherence, and have healthy relationships.

This is a historic moment in human history. We know what works in the effort to combat major killers of children and we are in a unique position to further reduce childhood all-cause mortality and virtually eliminate new pediatric HIV infections while keeping mothers healthy.

The focus on adolescents living with HIV is important to USAID and part of a greater initiative to meet the health needs of children.  For fifty years, USAID has been committed to improving child health.

In June, the Child Survival Call to Action challenged the world to reduce child mortality to 20 or fewer child deaths per 1,000 live births in every country by 2035.  Reaching this historic target will save an additional 45 million children’s lives by 2035.

Fifty-six governments and over 100 civil society partners committed to sharpening national plans for child survival, monitoring results, and focusing greater attention on the most disadvantaged and vulnerable children.

For children and adolescents living with HIV, we must manage their care with the desire and actions that show their self-worth including treatment and clinic adherence.  And let’s continue to prioritize meeting essential needs so children and adolescents can make a healthy transition into adulthood and a fruitful, productive life thereafter.

Join the USAID-sponsored International AIDS Society satellite:  Journey of Life for Children Living with HIV – From Diagnosis to Adulthood Sunday, July 22, 2012 from 9:00-11:00.

From Evidence to Action: What Works for Women and Girls

In the coming days, thousands of political leaders, public health experts, activists, people living with HIV and other delegates from around the world will gather in Washington D.C. to debate, discuss, reflect upon, and celebrate the achievements that have been made in the fight against HIV/AIDS.

But in Lesotho, and other southern African countries, the epidemic remains a painful reality.

During my recent trip to the Mountain Kingdom, a tiny country surrounded on all sides by South Africa, conversations about the epidemic inevitably turned to the fact that women and girls are a much greater risk for HIV due to a combination of biological, structural, and cultural conditions. In many ways, Lesotho clearly illustrates the nature of the epidemic in sub-Saharan Africa, where 60% of those living with HIV are women. In the nine countries in southern Africa most affected by HIV, prevalence among young women aged 15-24 years is on average about three times higher than among men of the same age.

In Lesotho, where women and girls have much higher rates HIV than men, our U.S. President’s Emergency Plan for AIDS Relief (PEPFAR) Country Team and implementing partners are acutely aware of the realities facing women and girls and are continuously seeking ways to ensure that programs and services use the most up-to-date evidence to meet their needs.

Fortunately, the evidence of what works for women and girls is just a click away.

What Works for Women and Girls: Evidence for HIV/AIDS Interventions

First launched at the International AIDS Conference in Vienna in 2010, this groundbreaking resource is a comprehensive website documenting the evidence for effective HIV interventions. Spanning more than 2,000 articles and reports with data from more than 90 countries, What Works for Women and Girls contains—in one centralized, searchable location—the evidence of successful gender-specific programming from global programs and studies, with a focus on the Global South.

Having the evidence of what works is crucial for organizations working on the front line of the HIV/AIDS response. In Kenya, for example, the evidence has been essential for crafting national policies on gender-based violence and HIV prevention for women.

From Evidence to Action

As we celebrate the rich evidence base in What Works for Women and Girls, we must now focus on what this means for the implementation and scaling up of the HIV/AIDS response. How can we ensure that the evidence is applied correctly and consistently to ensure quality programs at scale? Are our programs and services addressing the underlying gender inequities that not only put women and girls at risk for HIV, but men and boys too? How will we use the evidence to inform sound public health policies and priorities?

Most importantly, how can we ensure that the available evidence helps us to maximize the benefits so that we can, finally, turn the tide against HIV/AIDS?

For the women and girls of Lesotho, and across the southern Africa, there is not a moment to lose.

The Right to a Nationality: Women and Children

Anne C. Richard serves as Assistant Secretary of State for Population, Refugees, and Migration. This article was originally posted to DipNote, the  U.S. Department of State official blog

On July 11, leaders from around the world are meeting in London at the Family Planning Summit to express support for a fundamental component of reproductive rights — the right of every woman to decide freely and responsibly whether, when, and how many children she will have. This is a right most women in the United States have had the luxury of taking for granted in recent generations, unlike women in developing countries where 99 percent of all maternal deaths occur. The statistics are staggering — every two minutes a woman dies of pregnancy-related complications. For many, limited access to voluntary, safe, and effective modern contraception, information, and services becomes a matter of life and death.

More than 200 million women and girls in developing countries who want to use family planning to delay or avoid becoming pregnant do not have access to modern contraception. Addressing this human rights issue and health inequity has been a priority for the Obama Administration, because we understand the linkages between family planning and women’s health and a wide range of development issues including poverty reduction, girl’s education, maternal and child health, gender equality, and environmental sustainability. For over 40 years the U.S. government, through the work of the U.S. Agency for International Development (USAID), has been committed to supporting effective and sustainable family planning programs. In this fiscal year the U.S. contributed over $640 million through USAID for bilateral family planning and reproductive health programs, and $35 million to the UN Population Fund (UNFPA), which is a world leader in providing life-saving family planning and reproductive health information and services.

Hosted by the U.K. government and the Bill & Melinda Gates Foundation with support from UNFPA, the Family Planning Summit will build on this solid foundation. The Summit will seek financial and political support to provide access to contraceptives, information, and services for an additional 120 million women in the poorest countries. The goal is that by 2020 a total of 380 million women and girls in developing countries will be able to plan the number, timing, and spacing of their children. By meeting this need for contraception, maternal mortality would be reduced by one third and deaths of children under five reduced by one quarter. Reducing unintended pregnancies would also lead to fewer girls dropping out of school — and the longer children stay in school the higher their lifetime earnings will be, enabling them to lift themselves out of poverty. Families become healthier, wealthier, and better educated as the benefits pass to the next generation because mothers who have had an education are more than twice as likely to send their own children to school as mothers with no education.

Every woman and girl deserves the opportunity to determine her own future — it’s what we all want and work hard to achieve for our own children. We’ve long since come to expect that most mothers in the United States will live through the process of giving birth, to love and nurture their children, to contribute to the health and well being of their families, and to play a meaningful role in their communities and the prosperity of our country. We should expect and accept no less for all women and girls — regardless of income, education, and geography. We all deserve the opportunity for healthy, happy, and productive lives.

Protecting the Lives of Women and Girls: London Summit on Family Planning

Today I joined leaders from around the world at the London Summit on Family Planning to commit to the goal of providing 120 million women in the world’s poorest countries with lifesaving contraceptives, information, and services by 2020. This Summit comes at a crucial time, following up to last month’s Child Survival Call to Action. Convened by the governments of the United States, Ethiopia and India, the Call to Action brought over 1,000 representatives from around the world to Washington, DC to rally behind the goal of ending preventable child death. We know that this effort begins even before a child is born. By enabling mothers and families to time and space the birth of their children, family planning could save the lives of more than 1.6 million children under five annually.

To support the aspirations of the London Summit, the United States commits the power of its voice and example, as well as resources, technical support and leadership that will lead to new and innovative ways of substantively reducing unmet need for family planning. Over the course of several decades, the U.S. has provided roughly 50 percent of total donor funding in family planning.

In the last four years alone—during the Obama Administration—we’ve increased our commitments 40 percent, going from $470 million in 2008 to $640 million today.This past year, we reached more than 84 million women—helping to prevent 15,000 maternal deaths and save the lives of more than 230,000 infants.
I recently took a trip to Yemen where I saw the great challenges the nation faces in terms of both high rates of fertility and mortality. In Yemen, seventy-five percent of the population is younger than 30. Driven by a fertility rate of about 5.5 children per woman—nearly twice the regional average—each new generation is larger than the last. At best, these demographic challenges pose a roadblock for economic growth and global health gains. At worst, they interrupt the stability of societies—putting regional security and prosperity at risk. We need to make strategic investments today to get ahead of the curve and seize unprecedented opportunities in development. One of the biggest opportunities comes when you couple family planning with real reductions in child mortality—leading to an important shift in population that, with appropriate investments in education and job creation, can fuel as much as two percentage points of GDP growth for years.

Today, we’re building on our legacy of research and development to create a new generation of contraceptive methods that are easier to provide, easier to use, and more affordable. For example, we’re partnering with DFID, the Bill and Melinda Gates Foundation, and others to expand access to the popular “depo-in-uniject” contraceptive in five to six countries.  Packing an all-in-one, single dose, this innovative contraceptive can be provided right in the home.

USAID currently runs the largest and most effective global supply chain system in family planning commodities. But we need to work closely with our private sector partners and country governments to drive even greater efficiencies so we can avoid stock-outs and reach particularly vulnerable women in rural and urban settings. And we need to strengthen our partnerships, working closely with local actors, private firms and faith based organizations to fully integrate family planning services into HIV and maternal and child health programs.

Over the next eight years, our work to support more than 84 million women annually across 42 countries will provide for 675 million user-years of coverage. This is in addition to all the extraordinary commitments made at the Summit today. But combining our efforts, our support will ensure that, in 2020, 380 million women in the poorest countries of the world will have the power to determine the size of their families. By 2020, our work together will be helping prevent the deaths of 1.3 million children under the age of five—more than 15 percent of all preventable child deaths.

Alongside critical investments in education and economic opportunity for women and girls, voluntary family planning paves the way for peaceful, more prosperous communities. Ultimately, we know that long-term, sustainable development will only be possible when women and girls enjoy equal opportunity to rise to their potential.

I am excited with the level of energy and commitment surrounding this Summit and look forward to working together to lay the foundation for a brighter future.

Learn more about USAID’s work in family planning.

London Summit on Family Planning

Tomorrow, on World Population Day, world leaders will meet in London to discuss expanding access to family planning for millions of women around the world.  Many people have been asking me why the London Summit on Family Planning is important.  This brings me to think back to when my wife and I first thought about having children.  It was an exciting time; much thought went into planning our family.  We decided to have two children, spaced two and a half years apart, as that was the number we thought we could provide enough support, attention, and education.  For more than 40 years USAID has worked to enable millions of couples from around the world to plan their families like my wife and I did.

The London Summit on Family Planning is important because despite all the many advances in family planning, with countries that no longer need assistance in this area, for all the millions of couples who are now using family planning services, there remain millions who want to space or limit their families, but do not have access to the clinics, the commodities, or the services they need to do so.

In fact, the statistics tell the story:

Read the rest of this entry »

Taking Stock of Improvements in South Sudan’s Health Sector

As South Sudan celebrates the first anniversary of its independence on July 9, the new nation is taking stock of what it has accomplished over the past year.

After suffering through civil war for most of its history (since before Sudan’s independence from the United Kingdom in 1956), South Sudan remains one of the world’s least developed nations. Part of this underdevelopment stems from the fact that South Sudan had an informal health system during the war, which was supplemented heavily by relief agencies.  With a lack of skilled health professionals, vast distances between service delivery points, and a dearth of basic health education, the world’s newest country has some of the worst global health indicators, including one of the world’s highest rates of maternal mortality.

Overcoming the vast logistical, technical, political, and social roadblocks to improving health for the population of more than 10 million South Sudanese seems nearly insurmountable.  Deficiencies in infrastructure, human resources, supply chains, pharmaceutical management, education, and health policies produce challenges and delays at every step.

In addition to health and development needs, South Sudan continues to be challenged by conflict, instability, and population movements, including refugees fleeing conflict in Sudan and the return from Sudan of more than 400,000 people of South Sudanese origin since October 2010.  These conditions are taxing an already strained health system and exacerbating the existing deficiencies.

Despite these challenges, progress is being made. South Sudan’s child mortality rate dropped from 135 per 1,000 in 2006 to 106 per 1,000 in 2010. Infant mortality saw a similar decline from 102 per 1,000 in 2006 to 84 per 1,000 in 2010.

To sustain and expand these positive health trends, USAID is funding the Sudan Health Transformation Project, Phase II (SHTP II).  Led by Management Sciences for Health, SHTP II is working closely with South Sudan’s Ministry of Health and local partners to improve access to and demand for health services, while building the skills and knowledge of South Sudanese health workers.  One element of the project is the Leadership Development Program, which focuses on teaching health workers and managers how to identify challenges and seek solutions to overcome barriers to providing health services.  The program teaches teams to look at areas where they are underperforming, and find ways to achieve measureable progress.

At a recent workshop, Marco Agor, who works in the County Health Department in Tonj South, Warrap state, praised the program, saying, “The Leadership Development Program is very important. In my office, we had a lot of organization problems.  Those who had known Thiet in Tonj South before [the program] would say it is a different place. Now, Thiet is the best-run facility.”  The program has been so successful in SHTP II-supported facilities that the Ministry of Health is now assessing its own operational challenges using the Leadership Development Program. The Ministry is also currently working to develop a strategy for training even more of the nation’s health workers in this leadership development program.

Video of the Week: 5th Birthday Campaign

We can work together to end preventable child deaths.  Learn how at http://5thbday.usaid.gov.

Picture of the Week

Health workers practicing Helping Babies Breathe (HBB) techniques. HBB is an evidence-based educational program to teach neonatal resuscitation techniques in resource-limited areas. Since September 2010, the USAID-funded Health Care Improvement project has trained 691 providers in 9 out of 34 provinces on essential newborn care and resuscitation using the HBB curriculum. Implementing Partner: Health Care Improvement (HCI) Project Photo Credit: USAID/Afghanistan

 

 

From the Field: Imams Encourage TB Treatment in Tajikistan

As a community health specialist with USAID’s Quality Health Care Project in Dushanbe, Tajikistan, I educate community members, medical workers, patients, and their families about tuberculosis (TB) diagnosis, treatment, and infection control.  My job involves being constantly available and responsive to the needs of patients and their families, and I tend to work unusual hours in order to fit into their schedules.  Still, I was a bit surprised when I received a call from Safarov Khudodod in the middle of the night last month.  Khudodod is an imam, a religious leader at his mosque, and he was so excited about a TB testing referral he made after his sermon that he couldn’t wait until the morning to share it with me.

“I heard the man coughing and approached him to ask him about his symptoms.  I encouraged him to get tested.  He just reported back to me that he tested positive for TB and will begin treatment immediately,” he said.

Imams in Tajikistan play a major role in the lives of their congregations.  They lead ceremonies such as weddings and funerals and provide religious advice to those seeking it.  USAID is working with religious leaders in Tajikistan to inform them about the causes and treatment of TB.  USAID workshops are helping participants like Imam Khudodod to encourage known TB patients in their communities to get treatment and teach them how to avoid transmitting the disease to others.  I meet with workshop participants several times a year to help them complete self-designed outreach plans.  The 62 people we’ve trained have already reached approximately 20,000 community members.

Before he attended USAID’s TB workshop, Imam Khudodod told us he knew very little about TB.  “Before, we thought that TB was a genetic disease, but now we know it isn’t.  Many people in my community think that TB isn’t curable, so they don’t get treatment.  I share information about TB at all of my meetings with my congregation, even at weddings and births.  I have already reached out to over 5,000 people.”

Tajikistan has the highest rate of TB incidence in Central Asia and one of the highest multi-drug resistant TB rates in the world.  Encouraging individuals to complete treatment and teaching them basic rules of infection control are key steps in eradicating TB in countries like Tajikistan.

Imam Khudodod is optimistic about the future of TB in his country:  “I think that the next generation will be healthy and will know about TB.”

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