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Reflections and Impressions from AIDS 2012

Last month, nearly 24,000 participants from 183 countries –  including over half from the U.S. – attended the 2012 International AIDS Society Conference (IAC) “Turning the Tide Together” in Washington, D.C. Thanks to President’s Obama’s lifting of the ban on visas for people living with HIV/AIDS, the conference was held for the first time in the U.S. in over 20 years – presenting a remarkably unique platform for the United States to highlight its accomplishments under PEPFAR and vision for an AIDS Free Generation.

President Obama’s video address at the opening ceremony re-affirmed the U.S. commitment to fighting HIV/AIDS. Secretary Clinton electrified the audience with her keynote address — highlighting PEPFAR’s progress, legacy and vision for the future. She announced increased funding to eliminate mother-to-child transmission of HIV and laid the groundwork to develop a blueprint for achieving an AIDS-Free Generation.

Other high profile notables, including President Clinton, bipartisan congressional leaders, including House Minority leader, Nancy Pelosi and Rep. Barbara Lee, former First Lady Laura Bush, and celebrities including Elton John, Annie Lenox, Deborah Messing and Whoopi Goldberg were also present — making their continued support and commitment to fighting AIDS loud and clear.

All in all, AIDS 2012 was an all-star event and an extraordinary opportunity for the vastly diverse participants to hear about game-changing scientific discoveries and state-of the-art technical updates, and to experience the lively booths and personalities at the global village.

USAID was visible throughout the week. Agency leadership, staff and partners contributed to satellite sessions, posters and abstracts. The Agency’s flagship Emerging Issues in Today’s HIV Response Debate Series – cosponsored with the World Bank – held its seventh and final debate on ‘Funding Allocations for HIV/AIDS’. Administrator Shah made multiple high profile appearances.  Alongside World Bank president Jim Kim and former Botswana President Festus Mogae, Dr. Shah opened the debate with commitments of future collaboration. In a symposium on Country Ownership alongside Minister of Health Dr. Kesete Berhan Admasu of Ethiopia, the Administrator explained USAID Forward.  At an elegant session at the Museum of American Women Art – alongside Ambassadors Melanne Verveer and Eric Goosby, GHI Executive Director Lois Quam, CDC Director Tom Frieden and Zimbabwe’s Deputy Prime Minister, Thokozani Khupe – he spoke about gender.

My Takeaway

Eight million people are now on treatment and the goal for 15 million by 2015 seems within reach. There has been so much progress; 30 years ago HIV was considered a death sentence, but now the life expectancy of a person living with HIV who adheres to treatment is similar to a person with a chronic illness, similar to diabetes. We now have a broad range of tools for prevention, including those we have been using – like circumcision, condoms, and PMTCT – and new ones that have just been introduced – like treatment for prevention and possibly future interventions like Pre Exposure prophylaxis (PrEP). A vaccine is closer to development. Costs have continued to decline: ARVs are less expensive and programs increasingly efficient. Treatment in many African countries now costs around $200 per year.

Country ownership is growing as lower and middle income countries are picking up increasing shares of the financial burden. The launch of the new PEPFAR guidance on Orphans and Vulnerable Children provides updated coverage for households, communities and social services.

Challenges still lie ahead.  There is an estimated $7 billion funding gap over the next three years. Incidence is declining, but the rate of decline is not sufficiently steep. To move the needle, we need to close the treatment gap, scale up access to voluntary male circumcision, and enroll more expecting mothers with HIV in PMTCT programs. And, while we have a broad range of tools, we must work with country leaders to apply them appropriately given the epidemic and the local context.

Recent microbicide and PrEP trials have underscored the challenges of adherence and retention, and the need to work outside as well as inside facilities to influence changes in behavior. Key populations are stigmatized and often have alarmingly high infection rates and limited access to critical services. Middle income countries with concentrated epidemics feel they are losing support as donors increase focus on high prevalence, low income countries.

The epidemic is aging. By 2015, in North America and Western Europe, half of the HIV population will be over 50 and new approaches to care and support will be needed – especially as those infected at birth become young adults and those in their 20s and 30s become senior citizens.

With all that lies ahead, the future looks bright – and USAID, as witnessed during the conference – will continue to be a leading technical force in the fight against HIV/AIDS. Our commitment to global health and HIV/AIDS, as seen since the beginning of the epidemic and over the past 30 years, will continue to lead to major contributions and progress in the field.

The 500 Pound Gorilla: Addressing the Structural Drivers of HIV

AIDSTAR-One is funded by the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR) through the U.S. Agency for International Development (USAID), and provides rapid technical assistance to USAID and U.S. Government country teams to build effective, well-managed, and sustainable HIV and AIDS programs, and promotes new leadership in the global campaign against HIV.

During the recent International AIDS Society Conference in Washington, DC, exciting breakthroughs in HIV prevention, treatment, and care—even a possible cure—took center stage. But despite recent advances, many men and women remain at risk of HIV as a result of structural issues that fuel and have an impact on the epidemic. Structural Interventions reduce individual HIV-related vulnerability by creating conditions that enable people to adopt safer behaviors. Addressing gender inequality, poverty, stigma, and other social, economic, cultural, and legal factors is necessary to create an “enabling environment” for these promising biomedical and behavioral interventions.

There is increasing agreement worldwide that structural issues are too often overlooked where HIV prevalence remains high. Women who are not empowered to take charge of their sexual lives cannot practice HIV prevention, be it in the form of condoms or pre-exposure prophylaxis. Most-at-risk populations, such as men who have sex with men, will not seek out prevention and care services if they fear stigma or prosecution. Countries that cannot afford an extensive public health network cannot offer voluntary medical male circumcision or antiretroviral therapy to its rural citizens.

Unfortunately, specific operational guidelines, definitions, and evidence to clearly guide implementation of scalable structural approaches remain inadequate. To fill this gap, the U.S. Government and the global HIV community are working toward achieving consensus on how to prioritize which structural interventions. Addressing structural drivers can have a tremendous impact on the epidemic, but bringing promising approaches to scale requires sustained investment, a significant challenge in the face of competing priorities and tightening budgets.

Recent PEPFAR guidance recognizes the importance of addressing structural drivers as part of a comprehensive combination prevention package of services. At the International AIDS Conference, USAID – along with other U.S. Government agency staff, implementers, researchers, and policymakers – discussed the structural issues that impede progress, with the goal of building consensus to move forward.

The challenge is figuring out which structural approaches will achieve the maximum impact within different contexts. Implementers at the community level know that addressing structural drivers—which are deeply entrenched in social, economic, and political systems—requires sustained investments with strategies tailored to local contexts. Identifying what works is also difficult. Although there is increasing evidence that supports the links between these factors and HIV, measuring change can often be hard in relatively short-term project lifecycles. Experts also disagree on which types of evaluation methods are adequate to demonstrate change, and balancing the need to address these factors while also scaling up other proven interventions continues to be a challenge. Because structural drivers are linked to the very fabric of social, economic, and political systems, they often require a broader sector response, unlike more narrow biomedical and behavioral approaches.

Nonetheless, and despite the existence of clear guidance, some countries are making great progress in this area. For example, Zambia is integrating structural approaches into its national HIV framework through a multisectoral response. Key successes in Zambia’s national strategy have been strengthening collaboration and coordination across sectors and investing in a community-driven process. Panelists at a satellite session on the topic at the International AIDS Conference discussed some of these initiatives. For example, the Zambia Land Alliance is working with local authorities to ensure the availability of land for vulnerable populations, which helps address the lack of access to property that increases women’s vulnerability.

The best strategies for lifting structural barriers will be context specific, and will ultimately come from local communities. But to achieve widespread success, the response will also have to be coordinated with and supported  by national and international strategies and—given limited resources—strategically integrated into other combination prevention program areas. Easier said than done, but acknowledging the challenges and building consensus are two positive steps in moving one stubborn gorilla.

Learn more about structural approaches to HIV prevention at AIDSTAR-One.

A Global Partnership for Vaccine Design

When you’re dealing with a global public health crisis, having an international presence isn’t just advisable – it is imperative. This applies as much to the development of new tools to prevent disease as it does to treatment. An AIDS vaccine candidate, for example, must be tested in the people who will eventually use it and against the strains of HIV it is devised to protect them from.

That’s why the International AIDS Vaccine Initiative (IAVI), in partnership with USAID, has worked diligently over the past several years to establish itself as a truly global non-profit partner. Using donor funds, IAVI has created an enviable network of research centers in sub-Saharan Africa dedicated to assessing novel AIDS vaccine candidates in clinical trials and conducting supporting epidemiological studies on HIV. These partnerships have made meaningful contributions to the research capacity of many developing countries—a capability that is now helping local researchers tackle other diseases.

IAVI and its partners are now applying that same model to support the design of a new generation of AIDS vaccine candidates. Today, IAVI and the Translational Health Sciences and Technology Institute (THSTI), an autonomous institute of the Indian government’s Department of Biotechnology (DBT), launched an HIV Vaccine Design Programme near New Delhi. The Programme is dedicated to the large-scale generation and preclinical evaluation of immunogens, the active ingredients of vaccines. It will focus on devising immunogens capable of eliciting antibodies that can prevent infection by a broad range of the circulating genetic variants of HIV.

That challenge, known to researchers as the neutralizing antibody problem, has long stymied progress toward an AIDS vaccine. But recent discoveries of antibodies capable of blocking a number of HIV variants have provided researchers with clues to the design of potentially powerful new vaccine candidates. The HIV Vaccine Design Programme will use these insights to develop new methods to generate large numbers of potential HIV immunogens and rapidly assess their potential for use in candidate vaccines. Much of the work will take place in a laboratory housed within THSTI that is being built and staffed with support from IAVI, DBT and THSTI.

The Programme’s location is no accident. Over the past decade, IAVI has enjoyed a productive partnership for the clinical evaluation of candidate AIDS vaccines with key medical research institutions of the Indian government. Indian scientists have also actively participated in an international consortium of HIV laboratories supported by IAVI to advance HIV vaccine research. The government of India, meanwhile, is in the early phase of its “Decade of Innovation”, a policy that seeks to harness a growing roster of home-grown biotechs, the nation’s deep pool of scientific talent and global research partnerships to boost innovation in a variety of high-tech fields.

The HIV Vaccine Design Programme provides an opportunity to engage an emerging economy in the global quest to develop a vaccine against HIV. For India, it creates an opportunity to address a crisis of significant relevance to Indians.  As importantly, it seeds the kinds of collaborations that often foster scientific and technical innovation and generate ideas that might be applied to address other diseases that have long hampered development.

Meeting the Reproductive Health Needs of Young People

I first became interested in family planning and reproductive health during a class on health and developing countries in college. It was fascinating to me to learn how access to reproductive health has far-reaching health, economic, and societal impacts. However, I didn’t start focusing on the particular reproductive health needs and rights of young people until I studied abroad in northern Nigeria.  There, I met young women and men who had frighteningly incorrect information about sexuality, pregnancy, and HIV.  In the market, I saw 12- and 13-year-old girls who were dressed to advertise their eligibility for marriage, and I was told they would begin childbearing within the next year or two.  When I graduated from college and started in my position as a Policy Fellow in USAID’s Office of Population and Reproductive Health, I brought these lessons with me.

We young people are often accused of focusing too much on ourselves.  But as the world’s largest ever generation of young people begin to enter their reproductive years, a focus on meeting the reproductive needs and rights of young people is well deserved. This Sunday, International Youth Day, gives us the opportunity to celebrate young people and reflect on their  diverse needs around the world.  Approximately 16 million girls between the ages of 15 and 19 give birth each year, and complications from pregnancy and childbirth are a leading cause of death for this age group in developing countries.  Girls who become pregnant often face discrimination within their communities, drop out of school, and are sometimes forced into early marriage. Girls who become pregnant are more likely to have a lower income and have more children at shorter intervals throughout their lifetime. In contrast, young women who avoid unintended pregnancy are more likely to stay in school; participate in the work force; and have healthier, better-educated children.

In April, I had the opportunity to serve as a youth delegate on the US delegation to the UN Commission on Population and Development.  This year’s theme was adolescents and youth, and I’m proud of the bold outcome document adopted by member states.  It addresses the real needs of young people for comprehensive education about human sexuality; gender equality; and removal of legal, regulatory and social barriers to reproductive health information and care for adolescents.  The resolution also urges governments to protect, “the human rights of adolescents and youth to have control over and decide freely and responsibly on matters related to their sexuality, including sexual and reproductive health.”

Choices made about health-related behaviors and habits adopted during the transition years between childhood and adulthood can have either a positive or negative impact on future health and social well-being. Reproductive health constitute a key component of a healthy transition to adulthood, which is why USAID works across the globe to help improve education and access to youth reproductive health information and services. We are working  to harness the energies of young people as we  help them realize their full potential.  We see them as the future and want their valued  contributions  to and participation in the social, economic, political, and cultural life of their communities.

New Tumblr Features U.S. Action on Child Survival

The Child Survival Call to Action was a momentous occasion where participants from over 80 countries came together and renewed their commitment to end preventable child deaths.Screenshot of Call to Action Tumblr

Over one month has passed since the Call to Action, and many stakeholders are working hard to support the sustained effort led by UNICEF: A Promise Renewed.

There is a lot of promising activity and one way we will share progress is through a new tumblr blog. We’ll be updating this feed with quotes from U.S. Government officials, new products like fact sheets, and photos from field visits and follow up events. Our goal is to show the U.S. Government’s continued support and emphasis on children’s health and survival.

Please check the blog for updates and you can also follow the #promise4children hashtag on Twitter.

Thinking Across Borders in Southeast Asia

Earlier this month, I traveled to Cambodia to join Secretary Clinton at the Lower Mekong Initiative (LMI) Ministerial meetings where we launched “LMI 2020” – a deepening of the United States’ commitment to  Southeast Asia through a set of new activities aimed at strengthening regional coordination on development challenges facing the Lower Mekong region. 

“LMI 2020” seeks to advance knowledge and understanding of the environmental and health implications of economic and infrastructure development along the Mekong River, one of the most bio-diverse fresh-water ecosystems on the planet, as well as to strengthen the capacity and coordination of government, civil society and academic/research institutions in the region on these issues.  These new assistance programs support the LMI pillars of environment, education, health and connectivity which are co-chaired respectively by Viet Nam, Thailand, Cambodia and Laos.  But one of the most exciting outcomes was the formal welcome of Burma as a full participant in the Lower Mekong Initiative and the adoption of a fifth pillar on Agriculture and Food Security that Burma will co-chair.

The Lower Mekong Initiative was launched in 2009 as a framework for addressing the transnational challenges posed by infrastructure development along the Mekong River and a way to share information and analysis and to improve coordination amongst the countries in the region as well as donors.  Hence a parallel effort, bringing together the “Friends of the Lower Mekong” (FLM) around the table with the Mekong countries, has also become a critical way of aligning programs and policies.  I was struck by how far our partnerships under the LMI framework have progressed in the three years since it was launched. LMI partners now regularly discuss challenges with each other, at the highest political levels as well as in technical working group meetings, on issues such as the impact of proposed hydropower projects on the main stem of the Mekong River, or the need to coordinate to fight emerging pandemic threats.

After several days of productive meetings in Phnom Penh surrounding the U.S.-ASEAN Ministerial meetings, I then traveled to Siem Reap  to participate in  the Lower Mekong Gender Equality and Women’s Empowerment Policy Dialogue, which USAID co-hosted along with the State Department and the Royal Government of Cambodia’s Ministry of Women’s Affairs to highlight the role of women in the fostering sustainable development in the Mekong region. Secretary Clinton gave an inspiring speech on women’s rights as workers and the need to ensure opportunities for all girls and women. USAID has committed to support women leaders in the region to build a network to address critical transnational issues, such as environmental resources management.  Listening to the dynamic and vibrant women participants at the conference, it was clear to me that the potential in the region to achieve inclusive and sustainable growth could not be achieved without the full and active participation of women.

For more information, see the fact sheets on LMIthe Asia Pacific Strategic Engagement Initiative (APSEI) and more at http://www.state.gov/r/pa/prs/ps/2012/index.htm

Ask the Expert: Administrator Shah on the AIDS fight

Dr. Rajiv Shah serves as the 16th Administrator of USAID and leads the efforts of more than 8,000 professionals in 80 missions around the world.

Dr. Rajiv Shah serves as the 16th Administrator of USAID and leads the efforts of more than 8,000 professionals in 80 missions around the world.

Originally published at Global Pulse, by John Donnelly and Charles M. Sennott.

Q: Secretary of State Hillary Clinton announced this week that the administration would be put together a blueprint in five months for an “AIDS-free generation.” She first announced this vision eight months ago. Why does it take 13 months to put together a plan?

A: Let’s start with the goal. We were all very committed to create an AIDS-free generation. … We want to take a very honest and rigorous approach. We know it will require resources. We know it requires a great deal of local knowledge and development insights to say which communities are transmitting the most, how are we going to reach them, how do you reach people who are not as symptomatic? And what are the implementation strategies that are going to allow us to target and maximize outcomes against this goal?

We are trying to step through that in a very rigorous way. We are not holding anything up by doing that analysis. We’re embarking on an aggressive scale up of treatment, of prevention, of country ownership, of investing in country systems, even as we craft a blueprint that completely guides this country and our global partners for sometime in the immediate future.

Q: Is there a need for a blueprint, and is there wisdom in waiting for the results from the HIV combination prevention trials, which will test different approaches to reduce infections all at once?

A: The HIV combination prevention trial in Tanzania is particularly important because that’s probably the largest scale among them. It’s going to add a great deal of knowledge and data. But the reality is the pathway that defines success is going to look different based on the unique characteristics of the pandemic in countries and in communities. We need to do those trials and learn from them. We also are moving ahead with the aggressive presumption that combination prevention, including treatment as prevention, can be an effective strategy to get to an AIDS-free generation.

Q: Regarding male circumcision, you’ve had some problems in creating demand, such as what you’ve seen in Swaziland. What approach do you use now?

A: We need to apply more local insight, partnership with local institutions, better understanding of local behaviors and cultural preferences in how we scale up male circumcision programs. It is a medical intervention that has lots of data to substantiate its efficacy, but it is also a very personal and very significant cultural statement that we even in the United States in parts of our country debate and struggle with.

The big lesson learned is to take a little bit of time to be consultative with local partners who really know and are from the cultures in which we hope to scale up access to the intervention. I think we are working in the context of an aggressive scale up of male circumcision.

Q: The closing of the Global Health Initiative office ended the original dream of moving GHI to USAID. Are you disappointed that the dream didn’t materialize?

A: I kind of focus on what works and what doesn’t work, and what’s necessary to achieve our goals at a particular time. Our administration has set three critical health goals for our work: an AIDS-free generation; child survival call to action and eliminating preventable childhood death; and the virtual elimination or significant reduction of mothers who die in childbirth.

But what we learned in order to achieve them, we can’t have the current situation, where the US is keeping its funding constant in a tough global economy, but others are doing a little bit less. We know we need to have more focus and a more integrated approach. In the call to action we bring together malaria, preventing infections from mother to child, nutrition during the first 1000 days, GAVI and other immunization, and therapy for pneumonia and diarrhea. Let’s think of these as a combination approach to achieve the results of saving 5.5 million kids.

I know from my conversations with the president and the secretary that that’s their expectation — we are delivering on that. So, you know, the organizational structuring of it evolved in order to take on these goals and to address these challenges that were in our midst. Remember, GHI was launched before funding challenges existed both for US and abroad, and I think this is responsive to the reality of what’s needed.

Q: But GHI was perceived as the signature global health program of the Obama administration.

A: Just because we don’t have a Global Health Initiative coordinator at the State Department anymore doesn’t mean we don’t have a Global Health Initiative. We believe this structural approach will be more effective in delivering the kind of integration across services that we think is at the crux of getting health outcomes for the same resources, which is what GHI is about. It is true: We had a structure, we didn’t think it was the right structure to deal with the challenges going forward. We made changes to that, but we are absolutely committed to the GHI, to the goals we’ve established and to the concept of integrating service delivery to drive better results.

Q: At a panel at the Kaiser Family Foundation, Mike McCurry called on the Obama administration to articulate one clear global health goal – not three or five. But one. What do you think of that?

A: Mike was dead right. We got to this point by focusing on immunization, focusing on getting malaria bed nets to kids, focusing on HIV/AIDS. We still need to do that. But going forward, as Mike suggested, we need integrating concepts, concepts that people can be inspired by, that are operational and real, but that bring things together so that we are not competing with each other and instead grow enthusiasm for the overall effort.

That’s what the call to action for childhood survival was all about. You see 80 countries show up in the Washington meeting, co-hosted by India, Ethiopia and the United States. Fifty-six countries signed a pledge to eliminate preventable childhood deaths. Probably 20 some have already published scorecards to demonstrate how they are going to measure that. The US agencies and others have all agree to highlight the annual rate of reduction in childhood deaths as an operational metric to focus on across all of our grants. That’s the kind of coming together around something big, inspiring, and very genuinely country driven that I think will define success in the next decade for global health.

Q: Why did the call to action work then?

A: I don’t know the analysis, I just know the answer to the question. It’s somehow the energy is coming from the countries. We had a mid-level delegation from Yemen come to the Washington meeting, and they were so inspired that when they got back, when I got to Yemen the next week, the president of Yemen and deputy health minister both approached me and said, ‘We want to be part of this call to action. We looked to our statistics, we feel we can do better.’ When that happens, and that’s the demand signal we’re getting, that to me is what this should all be about, as opposed to our trying to construct something that then we ask others to respond.

Q: The phrase ‘turning point’ is used a lot when it comes to the AIDS epidemic. Do you use that phrase, and if so, why is it a turning point?

A: Well, the pandemic, the turning point, my understanding, the way I use it, is to refer to a specific moment when the number of global new infections is lower than the number of people added to treatment. Every year after that, you are reducing the number of people with the disease. We are not there. We are still in situation where the aggregate number of people with the disease is growing, so the turning point is a very important concept because once you hit that point you are on the decline and you can legitimately say we’re working statistically downhill toward zero. But the drivers of the turning point are what’s critical. That’s where you see that expanding prevention in a focused way that reaches the most transmitting populations is critical to achieving the turning point. And expanding efforts that effectively reduce risky behaviors so that you don’t have another turning point, and go back up again, are all critical to solve AIDS over the long term. So I think it’s a very viable concept.

A Vaccine to Help End the AIDS Pandemic

A new energy animates the hallways of the Washington Convention Center this week, as leaders and advocates commit to a goal once thought impossible: ending the AIDS pandemic.

Indonesian volunteers light candles during a ceremony to mark World AIDS Day in Jakarta. Photo Credit: Adek Berry/AFP

Attendees at the AIDS 2012 Conference here in Washington, and at conference hubs from Nairobi to Chennai, are telling the world that we can end the AIDS pandemic. Among the astonishing accomplishments in our battles against other infectious diseases that allow us to believe this bold claim, is the long-sought eradication of polio. The world learned in January that one of the last holdouts of this viral disease – India – has not recorded a single new case of natural polio infection for more than one year.  Polio still needs to be defeated in a small number of countries, but one of its most stubborn reservoirs of the virus is clearly being drained. That is no small feat.

How was this extraordinary feat accomplished?

In short: through massive immunization campaigns and people working together around the world to end a common threat.

HIV is, admittedly, a far more challenging foe. The virus attacks our body’s immune cells, changes its appearance ceaselessly and incorporates itself into our DNA, where it cannot be extinguished. The deviousness of HIV has long challenged the brightest minds of science. But it is nonetheless a challenge that can be overcome—if, that is, we commit ourselves to supporting research and building on the progress scientists have made so far.

In the last three years alone, clinical studies have demonstrated that preventive HIV vaccines and microbicides are possible. Other research has shown that antiretroviral therapies can be used in various ways to prevent HIV transmission as well. Meanwhile, voluntary medical male circumcision is increasingly being used to reduce the risk of HIV infection.

Each and every one of these strategies must be added to the existing toolkit for HIV prevention—and used together as a tour de force—if we are to end the AIDS pandemic.

New impact modeling, conducted jointly by the Futures Institute and IAVI, suggests that the full implementation of the UNAIDS Investment Framework by 2015 could help turn the tide of this pandemic. The subsequent development and deployment of a broadly effective AIDS vaccine could then further bend the curve and bring us closer to truly ending the AIDS pandemic.

Recent advances have fueled optimism and lent a new momentum to the field of HIV vaccine R&D. This momentum must be sustained. IAVI and its many partners around the world are racing to build on this progress. We invite you to join us in our efforts.

A Shared Vision of Improving Lives

Three decades ago, when AIDS was ravaging communities around the world, some said it would be impossible to provide treatment in resource-poor countries. Others said it was impossible to stop the transmission of HIV from mother to child. And most said it was unimaginable to see the end to AIDS.

Those days are in the past. In this video, Roxanna Rogers, the director of the office of HIV/AIDS at USAID, describes the progress we have made in the battle against HIV/AIDS. “We haven’t ever been at a point in time where we can talk about a future where AIDS has virtually disappeared. Our vision is to make that happen,” she says.

That is a powerful vision, and one that can now be realistically considered in large part because of partnerships.

From the earliest years of the HIV epidemic, partnerships between donor agencies, health ministries, nongovernmental organizations and communities have resulted in HIV research, prevention and treatment programs that have brought us closer to the vision Ms. Rogers describes.

Partnerships provide a framework for building on gained knowledge. Partnerships allow people with different perspectives to work together, and partnerships have allowed us to make this vision of an end to AIDS a realistic goal.

One of FHI 360’s longest-standing partners has been USAID. For three decades, we have been working together as part of a larger effort in the fight against HIV/AIDS. Together we other organizations, we have contributed toward turning the tide on a devastating global epidemic.

Our collaboration has focused on access to HIV/AIDS services, capacity building in resource poor settings and effective HIV prevention technologies. The approach is comprehensive and driven by research, evidence and a long track record of engaging directly with the communities around the world that have been hit the hardest.

FHI 360 is committed to bringing every critical voice to the table to work together for lasting solutions. Our efforts succeed only when we have strong partnerships with governments, civil society organizations, the private sector and the communities we serve.

We invite you to view our video titled “A Shared Vision of Improving Lives.” It shows what a vision — and partnerships — can do.

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.

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