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Archives for Global Health

New Evidence on Child Marriage Prevention in Ethiopia

From November 25th (International End Violence Against Women Day) through December 10th (International Human Rights Day), USAID joins the international community for 16 Days of Activism Against Gender Violence. During this time IMPACT will highlight USAID’s work to combat gender-based violence.

Defined as a formal marriage or informal union before the age of 18 years, child marriage is a practice that increases a girl’s risk of school dropout, maternal mortality, short birth intervals, vulnerability to gender-based violence, and poor mental health, among other adverse outcomes. Estimates suggest that 1 in 3 girls in the developing world are married before the age of 18. In areas such as the Amhara Region of Ethiopia, the prevalence of child marriage (CM) is among the highest in the world, with 2009 estimates showing that 50% of girls were married before the age of 18.

To help address the needs of 50 million adolescents who are already married, USAID invested in programs through PEPFAR to reach more than 220,000 married adolescent girls in Amhara, Ethiopia with access to family planning, STI services, HIV services, financial literacy, and menstruation management.

To help combat child marriage before it happens, USAID invests in research to prevent CM in “hot spot” areas with high CM prevalence. In Amhara, Ethiopia, as well as hot spot regions of Tanzania and Burkina Faso, USAID is supporting an innovative five-arm study on the effectiveness and cost of community education, economic incentives, and educational support on delaying marriage among adolescent girls, compared to control communities not receiving interventions.

Join the conversation with @USAID on Twitter using #16days.

Join the conversation with @USAID on Twitter using #16days.

USAID promotes dissemination and use of new evidence on effective strategies for child marriage prevention. A 2013 study (PDF) published by Anastasia Gage, supported under the USAID-funded MEASURE Evaluation project, sheds new light on how exposure to behavior change communication (BCC) affects knowledge and attitudes on CM among parents and guardians in Amhara Region. Although parents and guardians often decide when and who a girl marries, little data exists on effective strategies to change CM attitudes and knowledge among these gatekeepers.

Results from Gage’s study show that almost all parents were exposed to CM prevention messages from 1-2 communication channels.  Social influence was important to parents. Parents who believed their communities disapproved of CM were more likely to believe that marriage before age 18 was too early and that their daughters had the right to choose their own partner. By addressing parental attitudes and perceptions, programs can change social norms around child marriage. Future BCC campaigns on CM prevention should address the role of social influence on parental behaviors and attitudes and reinforce the health, economic, and educational benefits of delayed marriage. Evaluations of BCC programs should include a comparison group, monitor interventions for coverage, and measure changes in behaviors and practices.

USAID continues to support data collection on CM. Since 1984, the Agency has funded more than 260 Demographic and Health (DHS) surveys, which allow for identification of areas with the highest prevalence of CM. USAID supports rigorous evaluations of conditional cash transfer programs to delay CM among girls in India and Bangladesh, countries that account for the largest number of child brides in the world.

Learn more about USAID’s policies to address CM in Ending Child Marriage and Meeting the Needs of Married Children: The USAID Vision for Action. This vision is part of a suite of interlinked gender policies including the U.S. Strategy to Prevent and Respond to GBV Globally, the Gender Equality and Female Empowerment Policy, National Action Plan on Children in Adversity, Youth in Development Policy and National Action Plan on Women, Peace & Security.

The Power of a Grandmother’s Love

USAID is observing World AIDS Day this year by celebrating ten years of our HIV and AIDS work under PEPFAR.

As we approach World AIDS Day 2013, children affected by and living with HIV/AIDS must remain central to the global response.  As the largest funder of programs that mitigate the impact of HIV/AIDS in the lives of children worldwide, PEPFAR would like to celebrate the courage and compassion of all the caregivers, the grandmothers, the mothers and fathers, the aunts and uncles and older siblings, who have stepped forward to care for children affected by the epidemic.

GoGo means Grandmother in most South African languages. Photo credit: Tash McCarroll/USAID

“GoGo” means Grandmother in most South African languages. Photo credit: Tash McCarroll/USAID

GoGo is an old woman with a young girl’s bright smile. She lives in a small, tin-roofed, two room house in Soweto, with eight of her grandchildren. When her first daughter died of HIV, she took in her three young children, the oldest of whom was named Precious. At the time, Precious was 14. She was a clever girl who always did well in school and loved learning. When her mother became sick, Precious was forced to drop out of school to take care of her younger siblings and mother. And when her mother died, Precious moved in with her GoGo, who had no income and no means to support Precious to continue her education. Just as Precious began to lose hope, Grace walked into their lives. Grace is a Child and Youth Care Worker (CYCW) with the PEPFAR- supported Isibindi project.

CYCWs are para-social workers that support orphaned and vulnerable children whose lives have been turned upside down by HIV/AIDS. Grace helped Precious return to school and supported all of GoGo’s grandchildren to be tested for HIV. When GoGo’s younger daughter died and she took in her three children as well, Grace helped ensure they were also tested as well. And when tests indicated that none of the children were HIV-positive, GoGo and Grace were relieved, but they knew that they would have to continue to protect themselves and support these children in order to maintain healthy lives. Thanks to help from Grace, GoGo was able to complete an application and gain access to a government grant to cover basic expenses.

Grace still supports the family and visits with them twice a week. She makes sure the children are attending school and doing well psychologically, and helps GoGo to meet their other needs. GoGo still has eight children in her care, but she does not seem burdened or discouraged. She looks to the future with hope. When complimented on the care that she provides to her grandchildren, GoGo responds, “Of course I do this work. They are my children. No one can hold them like I can.”

Learn more about USAID’s role as a leading implementer of PEPFAR programs for orphans and vulnerable children.

This story is part of an ongoing series of blogs from the Office of the Global AIDS Coordinator in recognition of the 10th anniversary of PEPFAR. Previous blogs in the series can be found on the PEPFAR blog site. 

Follow @USAIDGH on Twitter through World AIDS Day, observed on December 2, for key facts, resources, and photos from our programs and partners and join the conversation using the hashtag #WAD2013.

R.E.S.P.E.C.T Find Out What It Means To Us

From November 25th (International End Violence Against Women Day) throughDecember 10th (International Human Rights Day), USAID joins the international community for 16 Days of Activism Against Gender Violence. During this time IMPACT will highlight USAID’s work to combat gender-based violence.

It is no accident that Aretha Franklin’s rendering of “Respect” rapidly became an anthem for marginalized and disenfranchised individuals and groups. The denial of human rights, particularly the most basic rights, such as respect, touches on a universal chord.

In recent years, global attention has been growing surrounding the horrifying issue of disrespect and abuse of women during childbirth.

Indonesia Maternal Health

USAID’s presence in Indonesia has been vital to the success of various health initiatives. The Blue Circle campaign of the 1980s and the Bidan Delima program in 2005 are just two examples of these initiatives that made it possible for women, like those pictured waiting in line, to receive maternal and child health and family planning services at community health centers. Photo credit: USAID/Indonesia

Think about the treatment you, or your wife, sister or daughter, expect from your maternity care provider. He or she is responsible for helping you (or your partner) give birth safely. Can you imagine a doctor scolding you for not using family planning to control your fertility? Or being separated from your newborn because you don’t have enough money to pay the discharge bill? Or giving birth unclothed while visitors walk by?

In both developing and developed countries around the world, pregnant women experience disrespect that ranges from subtle denial of their autonomy to blatant abuse. Numerous studies (PDF) document physical abuse in childbirth, including slapping, restraining, suturing without pain medication, or forcibly pushing on a woman’s abdomen. For women carrying or at high risk for HIV, the fear of stigma and discrimination from providers is often compounded by stigma from partners and families, especially regarding HIV testing or positive status disclosure.

This lack of respectful care also deters many women from seeking hospital care; instead they choose to give birth at home without the care of a skilled health attendant. This increases the change of complications from childbirth, possibly causing death.

While some may blame healthcare providers, many of these providers are working under suboptimal conditions, with many being overworked, underpaid, and burdened with unmanageable caseloads. The lack of empowerment, dignity, and security for midwives and nurses is driven by deep-rooted attitudes derived from gender, class, caste, race and cultural norms towards women. These problems undermine the resilience of midwives and nurses and negatively impact their capacity to provide quality care.

What does respect for women giving birth mean? The Universal Rights of Childbearing Women Charter (PDF) clearly outlines what respect means; certainly it includes the physical safety of pregnant women, but it also includes the respect for women’s basic human rights, including respect for women’s choices, preferences, feelings, and autonomy. It also means addressing the conditions of healthcare providers.

To eliminate the humiliation and abuse of women in childbirth, USAID supports the White Ribbon Alliance to lead global and country level advocacy and the University Research Corporation TRAction Project (PDF) to carry out implementation research to assess the prevalence of disrespect and abuse and test approaches to decrease these behaviors. With USAID funding, the Jhpiego/MCHIP Project has developed a comprehensive Respectful Maternity Toolkit available throughout the world. Furthermore, USAID is partnering with the World Health Organization to review the evidence on the status and working conditions of midwives and address the disrespect and abuse of women in childbirth.

We see the need for increased awareness and support for civil society engagement and advocacy, and the need to work with all involved in the direction, management and provision of care to women giving birth. Global initiatives, such as the Third Global Forum on Human Resources for Health, are key opportunities to realize these basic human rights.

Until recently, this was a problem hidden behind a veil of silence. Now we hear the silence being broken across the globe, but it is just a start.  Women’s voices need to be heard. And all of us need to respond to promote social justice and improve quality of care. Women’s lives depend on it.

Meeting the Needs of Children and Adolescents Who Have Experienced Sexual Violence

From November 25th (International End Violence Against Women Day) through December 10th (International Human Rights Day), USAID joins the international community for 16 Days of Activism Against Gender Violence. The blog below highlights USAID’s work to combat gender-based violence and celebrates ten years of our HIV and AIDS work under PEPFAR in advance of World AIDS Day (December 1).

Ruth was doing “okay,” with the help of her HIV medication and the friends she had made in a local support group for people living with HIV. With a shy smile, Ruth told me that she was getting by, but she missed her two young daughters. Her nine-year-old, Sarah, had been raped a year before and was now at a recovery center with her sister, who stayed with her for company. “She still hasn’t spoken, but she is getting better,” Ruth said with a sad smile.

In Swaziland, just before sunset, a young girl tests out a new seesaw on a playground built by the Elizabeth Glaser Pediatric AIDS Foundation at the Mkhulamini Clinic. Photo credit: Jon Hrusa, Elizabeth Glaser Pediatric AIDS Foundation

In Swaziland, just before sunset, a young girl tests out a new seesaw on a playground built by the Elizabeth Glaser Pediatric AIDS Foundation at the Mkhulamini Clinic. Photo credit: Jon Hrusa, Elizabeth Glaser Pediatric AIDS Foundation

Like many single mothers, Ruth worked during the day doing laundry and chores for other families. A male neighbor took advantage of her daughter when she was home alone. The attack had been so brutal that her daughter had been in the hospital for over a month. With the help of friends, Ruth made sure the man was arrested and prosecuted. It had been hard. The time spent on the case had left little time to earn income. Ruth’s family was struggling, but people were helping. She had hope that things would get better, and that her daughter would recover.

Ruth’s story and her courage epitomize the struggle to achieve an AIDS-free generation. Treatment is a miracle, but the true test of our resolve to end AIDS lies in our commitment to end the inequities of gender, of rich and poor, of powerful and vulnerable.

Girls, often marginalized by age and social status, are at a particularly high risk. Globally, young women aged 15-24 are the most vulnerable to HIV and account for 22 percent (PDF) of all new HIV infections (twice as high as young men). Furthermore, an estimated 150 million girls have experienced some form of gender-based violence before age 18. But this is not just limited to girls. According to the World Report on Violence Against Children (PDF), an estimated 73 million boys globally have also experienced sexual violence before age 18. Such violence has severe consequences for their immediate and long-term health and well-being, including increased risk for sexually transmitted infections such as HIV, reproductive and sexual health complications, alcohol and drug abuse, and psychosocial health issues. In addition, results from the PEPFAR Sexual Gender Based Violence Initiative showed that when sexual assault services were introduced to primary health centers, a large percentage of patients presenting for care were under 18, but services were not tailored to meet their unique needs.

USAID, as a key implementing agency of PEPFAR, has a strong commitment to addressing the unique needs and vulnerabilities of children and adolescents experiencing sexual violence, including addressing the gender-related factors that underlie such violence. The recently launched guide, Clinical Management of Children and Adolescents Who Have Experienced Sexual Violence: Technical Considerations for PEPFAR Programs, offers step-by-step technical advice for clinicians, social workers, pediatricians, child protection workers, HIV specialists and others on appropriate clinical care and management. These technical considerations are meant to serve as a starting point for national level adaptation and development of comprehensive, integrated services for children.

As we travel down the road to an AIDS-free generation, we hope that stories like that of Ruth’s daughter dwindle into extinction. In the meantime, for those children that are afflicted by such unspeakable sexual violence, we pledge to continue serving their unique needs and vulnerabilities.

Fostering Leadership to Eliminate Mother-to-Child Transmission of HIV in Nigeria

USAID is observing World AIDS Day this year by celebrating ten years of ourHIV and AIDS work under PEPFAR.

More than 85,000 infants in Nigeria are at risk of HIV transmission from their mothers every year. While the number of HIV-positive pregnant women who receive antiretroviral treatment (ART) is increasing, robust efforts to improve coverage are needed if national targets (PDF) for prevention of mother-to-child transmission of HIV (PMTCT) are to be met in 2015.

Keziah Samaila, coordinator of PMTCT in Township Clinic, Nigeria, training women on Family Planning and HIV. Photo: Lourdes de la Peza

Keziah Samaila, coordinator of PMTCT in Township Clinic, Nigeria, training women on Family Planning and HIV. Photo: Lourdes de la Peza

Over the past year, the Leadership, Management and Governance (LMG) Project helped support the PLAN-Health Nigeria project, funded by PEPFAR through USAID and managed by Management Sciences for Health (MSH), to pilot Leadership Development Program Plus (LDP+), which focuses on empowering teams to improve PMTCT results. The program also emphasizes new approaches tied in to country ownership, national health priorities, and specific health indicators.

LDP+ was piloted in the town of Gwagwalada, Nigeria. The Gwagwalada Council is one of the five Local Government Area Councils of the Federal Capital Territory (FCT) of Nigeria. LMG and PLAN-Health worked with the Gwagwalada Council, which selected 20 participants—two from each of the 10 facilities providing PMTCT services in the area—to form 10 teams to participate in the LDP+. Together, the teams decided to address PMTCT and focused on improving some standard indicators such as number of new antenatal care (ANC) clients; number of pregnant women tested for HIV, counseled and received their results; and the number of HIV-positive women. The program ran from October 2012 to May 2013. During this time, the teams worked within their facilities to create a vision of improved results around PMTCT, align stakeholders around this vision, implement their action plans, and share learning with other teams to identify the most useful local interventions and activities. The teams also received coaching in the areas of monitoring, evaluation, and reporting.

Keziah Samaila from Township Clinic, left, and Joy Otuokere, right, from Zuba Health Center, singing during the LDP+ training in Gwagwalada, Nigeria. Photo: Lourdes de la Peza

Keziah Samaila from Township Clinic, left, and Joy Otuokere, right, from Zuba Health Center, singing during the LDP+ training in Gwagwalada, Nigeria. Photo: Lourdes de la Peza

Most of the facilities reported encouraging results for their key indicators after participating in LDP+. For example, the Old Kutunku Health Center reported an increase from 17 to 61 new ANC clients per month. At the Gwako health center, the percentage of ANC clients who delivered in a health facility increased from 18 to 42 percent. Prior to LDP+, the Township clinic counseled and tested the partners of only three percent of pregnant women, compared with 20 percent after the program.

Alfa Ndatsu from Gwako Health Center, presenting his team work on the challenge model during LDP+ training. Photo: Lourdes de la Peza

Alfa Ndatsu from Gwako Health Center, presenting his team work on the challenge model during LDP+ training. Photo: Lourdes de la Peza

The Gwagwalada Council’s oversight committee plans to continue the program with its own resources, expanding it to another eight facilities in the area. Through these efforts, this local government agency is furthering Nigeria’s national efforts to ultimately eliminate mother-to-child transmission of HIV.

Follow @USAIDGH on Twitter through World AIDS Day, observed on December 2, for key facts, resources, and photos from our programs and partners and join the conversation using the hashtag #WAD2013.

10 Years in the Making: Celebrating USAID’s Achievements Under PEPFAR

USAID is observing World AIDS Day this year by celebrating ten years of our HIV and AIDS work under PEPFAR.

In less than two short weeks, the global health community will unite to commemorate the fight against AIDS. The United States, foreign governments, civil society, local communities and many others dedicated to reaching an AIDS-free generation will mobilize around the world to celebrate the incredible achievements that have been made since the epidemic was first identified over 30 years ago.

We’ve come a long way in the last three decades: unexplained immune system failure and a race to identify the cause in the early 1980s; life-sustaining therapy introduced in the mid-1990s; a landmark foreign assistance initiative in 2003 that brought treatment to millions of people who had no access before; and a groundbreaking study in 2011 showing that healthy people living with HIV on antiretrovirals can limit transmission by 96 percent. The worldview of the HIV pandemic has changed dramatically in our lifetime.

The Building Local Capacity Project has reached 57,223 orphans and vulnerable children (OCV) and caregivers with child health services in southern Africa. Photo credit: Management Sciences for Health

The Building Local Capacity Project has reached 57,223 orphans and vulnerable children (OCV) and caregivers with child health services in southern Africa. Photo credit: Management Sciences for Health

Our work is not over. As Secretary of State John Kerry said during a speech earlier this year, “As progress continues, we will gradually evolve as our fight against this disease evolves, and that is going to happen both by necessity and by design. Achieving an AIDS-free generation is a shared responsibility and it is going to be a shared accomplishment.”

Some of the most monumental achievements in combating HIV and AIDS have occurred in the past 10 years with the creation of two unprecedented global health programs – the Global Fund Against AIDS, Tuberculosis and Malaria and the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR). PEPFAR was, and continues to be, ambitious, visionary, and far-reaching. Through access to antiretroviral treatment, it has literally brought people living with HIV back from the brink of death and enabled them to live long and healthy lives.

It’s been ten years since the United States Leadership Against HIV/AIDS Tuberculosis, and Malaria Act of 2003 was passed into law, creating PEPFAR. And today, we can confidently say that the program has saved millions of lives and delivered hope to communities where it was so desperately needed.

As a key implementing agency, USAID has contributed significantly to these remarkable achievements. Through programs that prevent mother-to-child transmission, offer voluntary medical male circumcision and improve condom use, to those that reduce gender-based violence and risky behaviors for select populations; through our commitment to deliver effective treatments and care for the most vulnerable – especially orphans and other affected children – to our support for the development of an HIV vaccine, USAID has played a significant role in changing the face of the pandemic around the world.

In the 10 days leading up to World AIDS Day  - through a digital campaign called 10 for 10 (PDF) – USAID will share stories from the last decade that touch on the various ways the agency has contributed to one of the most successful foreign assistance programs ever created. This campaign will culminate in the launch of “Gift’s Last Ten Years” – an animated video that tells the story of our work through the eyes of a fictional 10-year old southern African girl.

AIDS used to be a disease that everyone feared and discussed only in private. Today, there is a global sense of optimism that did not seem possible at the beginning of this century. What a difference a decade makes – we’re proud to have played our part.

Follow @USAIDGH on Twitter through World AIDS Day, observed on December 2, for key facts, resources, and photos from our programs and partners and join the conversation using the hashtag #WAD2013.

Achieving Equity Through Women in Leadership

I’ve just returned from the International Conference on Family Planning in Addis Ababa, Ethiopia, where thousands of leaders and experts came together to discuss how to improve access and choice in family planning services across the globe. One of the highlights of the conference for me was speaking on a panel about the role women leaders can play in this arena.

I don’t think you have to be a woman to be committed to achieving equity in access to family planning services.  There are countless men in leadership roles that are deeply committed to expanding equity across the board, including in access to family planning.  That said, I think having women in leadership positions is incredibly important.

Mother and child at a health clinic in Ethiopia. Photo credit: USAID

Mother and child at a health clinic in Ethiopia. Photo credit: USAID

We often talk about women leaders as role models for girls.  Certainly having women in leadership roles lets girls see someone who looks like them doing things they might dream of doing and helps validate those dreams.  But women in leadership positions are role models for boys too—that women belong in leadership positions, that having women in these roles is normative. Having women in leadership roles in government is an especially public acknowledgement of legitimacy.

Governments have a responsibility to treat their citizens equitably, which means they have a special role to play in addressing disparities, whether that is as a direct provider of health services or by making it attractive for the private sector to serve the underserved or both. When governments prioritize making it possible for poor women, rural families, adolescents, and racial or ethnic minorities to exercise their right to choose the number, timing, and spacing of their children by expanding access to high quality, voluntary family planning information, services, and methods, they send a message about their commitment to equity and rights.

Having women employed in visible roles in government programs, whether they are in formalized leadership positions or not, also sends that message.   And there are great examples all around us:

  • Managing the largest portfolio that USAID has in Asia, female Foreign Service Nationals at USAID’s Bangladesh mission have strengthened the family planning portfolio. Dr. Umme Meena in the mission there—and other men and women like her employed as Foreign Service Nationals by the U.S. government worldwide—demonstrate America’s commitment to equity in family planning every day.
  • In Amhara, Ethiopia, USAID supports activities to prevent child marriage by identifying young female community mentors who can advocate against marriage before the age of 18. These youth leaders are powerful agents of change and gender equity in their communities.
  • Community health workers are some of the most passionate and committed champions for equity in access to family planning and health services. Esther Nyokabi in Kenya is an illiterate woman who overcame significant personal obstacles to become a champion for post-abortion care. She mobilized her community to demand better health infrastructure from the government. She is now a passionate community health worker and part of a government –sponsored training team for post-abortion care. Her efforts have brought life-saving antenatal care, skilled attendance at delivery, and family planning services to a community that did not have health services previously.

It is the commitment, passion, and actions of leaders like these that will achieve full choice in family planning.

Watch a video clip of Ellen Starbird at the International Conference on Family Planning and read news and announcements made by USAID at the conference. 

A Lesson in Holistic Care: What I Learned from Working with Transgender Women and Health Providers in the LAC Region

November 20 is Transgender Day of Remembrance.

I have collaborated closely with transgender women and health providers in Latin America and the Caribbean to learn more about the needs of transgender populations and to train health workers to provide quality services. Working alongside transgender women on needs assessments, trainings for health providers, and in the development of a blueprint (PDF) for comprehensive transgender services, opened my eyes to their experiences, gaps in existing programs that limit access to critical services, and the opportunities we need to pursue. To help you understand my recommendations, I would like to share a story I heard repeatedly from transgender women:

I was 13 years old when my family threw me out of the house because of who I am. I tried to continue my studies, but I dropped out of school because my classmates insulted me every day and sometimes hit me, and I was afraid to use the boys’ bathroom (the only one I was allowed to use) because I was afraid of being assaulted by male students. The teachers looked the other way or called me names. I have developed a thick skin because when I step out of my home, people stare, make comments and give menacing gestures. Going to a clinic is also unpleasant. I get sick like everybody else, but the nurses always assume that I am a sex worker and that I have HIV. Frequently, they give me condoms and an HIV test and send me home. One time I was jumped by four guys in the street, and I ended up in the emergency room. When one of the nurses opened my robe and saw that I am a transgender woman, she gave me a look of disgust and called me a homosexual. She must have told others about me because several nurses came, opened my robe and walked away laughing. I waited for a long time before a doctor saw me. He told me that real men do not dress like women, and that I should cut my hair and stop wearing make-up so I could get a job. I had a cut in my head that needed stitches and the doctor did not even clean the blood in my hair.

REDTRANS and Miluska staff conducting a workshop on HIV and human rights. Photo credit: Manuel Contreras

REDTRANS and Miluska staff conducting a workshop on HIV and human rights. Photo credit: Manuel Contreras

This story, and the others that I heard through this work, underscored the need for a new approach to transgender health:

  1. Prevention efforts must engage families and schools to foster supportive environments.  Transgender teens frequently experience rejection from their families and bullying in school. Homelessness, low literacy, and lack of family protection not only increase the likelihood that these teens will experience exploitation, but also severely limit their opportunities to find jobs.
  2. Many people, including health providers, do not clearly understand the spectrum of sexualities, genders, and identities. Their confusion often leads to stigmatizing attitudes and discriminating practices in health care settings, which in turn discourages transgender women from seeking care.
  3. Increasing access to counseling and testing and other HIV services should not be an end in itself. Securing the human rights of transgender communities and creating a safer environment where they can access appropriate services without fear of violence or discrimination should be the focus.
  4. Increasing access to condoms and HIV information are cornerstones of HIV prevention, but national prevention programs need to go beyond these two strategies. Policies and programs should also support employment and education opportunities for transgender persons. The pressure to put food on the table and a roof over their families’ heads can lead to poor decision making, resulting in risk-taking behaviors.
  5. Engaging transgender persons in program activities as facilitators or data collectors strengthens their technical capacities and allows them to engage with health providers and communities as professionals and peers. This can effectively dispel myths and negative beliefs about transgender women, their capacity, and their behavior.

By sharing my observations and the stories I heard, I hope to raise awareness of the issues that come into play and to encourage all of us to reconsider how our programs can better contribute to the well-being of transgender persons and their communities. We can make that commitment today on Transgender Day of Remembrance, an internationally recognized day to memorialize those who suffered or died as a result of anti-transgender hatred or prejudice.

Aysa Saleh-Ramirez, MPH is AIDSTAR-One Senior Technical Advisor at John Snow, Inc. AIDSTAR-One is funded by PEPFAR through USAID.

Men for Others: Keeping Men Safe as They Battle Against HIV

November 19 is International Men’s Day.

Every day, the first thing I see when I walk in the office is a picture of a young dad tenderly holding his little daughter in southern Africa. She is sick and they are on their way to clinic. With her head safely snuggled on his shoulder, the solace in her soft brown eyes and round face says, “Thank you Daddy. Thank you for being here for me.”  His face, an expression of both love and deep concern, says in return, “I will always be here for you.”

He is a man for others. Although I never met him, he is a daily inspiration to me. He is like so many men (and women) I have met along our global journey to end AIDS. Men who give so much of themselves to take care of sons, daughters, partners, spouses, friends, and even strangers. These men “step up,” often facing great risks, to support those who need assistance.

A family celebrates with their child, a sign of togetherness and healthy living. Photo credit: USAID/B. Deutsch

A family celebrates with their child, a sign of togetherness and healthy living. Photo credit: USAID/B. Deutsch

Today, as we celebrate International Men’s Day, we need to “step up” for every man and boy, keeping them safe as they continue the battle against HIV.

This means prioritizing access to HIV prevention services like voluntary medical male circumcision (VMMC). Men and boys armed with the evidence and given access to preventive services will better protect themselves, their loved ones, and their communities. Millions of men and boys in east and southern Africa are already taking the lead through the vigorous uptake of VMMC services.

This means scaling up evidence-based structural and behavioral interventions to remove barriers to HIV services. For instance, programs that encourage men and boys to seek life-saving health services can counteract the negative influence of certain gender expectations. In addition, it is important to improve access to services for men who have sex with men by training health care workers and mobilizing communities in high stigma settings.

This means identifying more men and boys who are HIV-positive and enrolling them in quality HIV care and treatment services. We know antiretroviral treatment can give men and boys with HIV the opportunity to live longer, healthier, and more productive lives. Furthermore, men and boys on treatment can successfully suppress HIV and are less likely to transmit the virus to others.

This means continuing the search for a safe and effective HIV vaccine and possibly even a cure.

On this International Men’s Day, let’s continue our work to keep men and boys safe from HIV.  Let’s step up like that young dad in southern Africa and keep our promise to always be there for them in our fight against HIV.

Human Resources for Health: Foundation for Universal Health Coverage

Many USAID staff from Washington and the field gathered in Recife, Brazil this week for the 3rd Global Forum on Human Resources for Health (HRH), joining over 2,000 HRH policymakers, experts, advocates and frontline health workers from 57 countries. The Global Health Workforce Alliance convened the forum to find solutions to address the health workforce crisis. The global shortage of skilled, motivated and supported health workers is a major development challenge and a barrier to meeting health goals.  A strong HRH strategy ensures that new healthcare graduates are absorbed by the health system, and then well supervised and supported throughout their careers. Therefore, investment in HRH is essential for the delivery of high-quality health services and for countries to achieve and sustain universal health coverage (UHC).

A Yezura Zenna, or volunteer health aide, is ready to work in Ghana with his project bicycle and pharmaceutical bag.  Photo credit: James E. Phillips, courtesy of Photoshare.

A Yezura Zenna, or volunteer health aide, is ready to work in Ghana with his project bicycle and pharmaceutical bag. Photo credit: James E. Phillips, courtesy of Photoshare.

This year’s forum focused on HRH as the foundation for universal health coverage and the post-2015 agenda. USAID co-sponsored the forum and our Assistant Administrator for Global Health, Dr. Ariel Pablos-Méndez, led the U.S. Government delegation that included participants from the State Department and Health and Human Services. Many PEPFAR-supported USAID projects, including CapacityPlus, ASSIST, Leadership Management and Governance, and Health Finance and Governance also showcased their investments in human resources for health.

We took away several key lessons from our participation in the forum. Foremost, there must be better integration of HRH into the broader dialogue about health system strengthening and development goals and challenges. As Dr. Pablos-Méndez emphasized, the economic transition occurring in many countries is impacting HRH and should inform human resources planning so that health goals can be realized. Finally, we must build a new generation of leaders to help carry the HRH agenda forward.

USAID will continue to support health workforce strengthening in order to improve access to and quality of health services for the most at-need populations.  Our approach to HRH is comprehensive, focusing on the availability, accessibility, acceptability and quality of a country’s health workforce.  In addition to strong health systems, USAID supports the development and needs of all cadres that make up a country’s health workforce, including doctors, nurses, midwives, paraprofessionals and community health workers.

A community health worker counts the respiratory rate of a young child in Dhanusha, Nepal.  Photo credit: Dillip Chandra Poudel, courtesy of Photoshare.

A community health worker counts the respiratory rate of a young child in Dhanusha, Nepal. Photo credit: Dillip Chandra Poudel, courtesy of Photoshare.

USAID’s strong relationships with the Global Health Workforce Alliance and its members have enabled valuable collaboration on the global HRH agenda.  The notable willingness of donors and countries to join in partnership to tackle HRH challenges with country-appropriate interventions has led to a significant increase in investment for HRH at the country level.  This alignment will be instrumental in moving the HRH agenda forward in the post-2015 era.

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