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How Gender Analyses Shaped the Future of Microbicides

Engaging women in conversations about microbicides will help facilitate an effective introduction of this HIV prevention tool when it becomes available / Lisa Marie Albert

Engaging women in conversations about microbicides will help facilitate an effective introduction of this HIV prevention tool when it becomes available. / Lisa Marie Albert

Women account for more than half of all people living with HIV worldwide. In sub-Saharan Africa, young women are twice as likely to have HIV as young men. It is clear that women are disproportionately affected by the virus. Women’s vulnerability to HIV stems not only from a higher biological risk than men, but also from violations of women’s human rights, gender inequalities and marginalization.

USAID, through PEPFAR, is committed to expanding the array of woman-controlled HIV prevention methods so that women and girls can better protect themselves from infection../ Lisa Marie Albert

USAID, through PEPFAR, is committed to expanding the array of woman-controlled HIV prevention methods so that women and girls can better protect themselves from infection. / Lisa Marie Albert

USAID, through the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR), is committed to expanding the array of woman-controlled HIV prevention methods so that women and girls can better protect themselves from infection. In 2010, the CAPRISA 004 trial, funded in part by PEPFAR through USAID, provided the first proof of concept that a vaginal microbicide made of tenofovir gel could protect women against HIV infection when used appropriately. Microbicides are substances applied vaginally or rectally to protect users against HIV infection. This scientific breakthrough presented the global health community with a potential new, female-initiated tool in the fight against HIV.

With these encouraging findings and continued clinical trials to test microbicides, we now need to look ahead toward their meaningful introduction and use. Through this process, we will recognize potential barriers to successful roll out, and identify ways to mitigate those barriers. Are women interested in using microbicides, and if so, how easy will it be for women to access them? To what extent do women want to communicate with their male partners about microbicides? How accepting are men to women’s choices about HIV prevention? To what degree are policies supportive of women’s microbicide use?

One of our implementing partners, FHI 360, foresaw these concerns and acted. Under the USAID-supported Preventive Technologies Agreement, FHI 360, with support from Sonke Gender Justice in South Africa,  conducted gender analyses in South Africa and Kenya, two countries where microbicide development work makes its future introduction likely. Gender analyses are systematic processes used to identify and understand gender differences. They examine how gender norms and inequalities affect relationships and power dynamics between men and women, as well as women’s access to resources, their rights, their opportunities, and their health practices and outcomes. In South Africa and Kenya, FHI 360 implemented this analysis to understand gender-related barriers to women’s microbicide use, identify solutions, and prepare for a gender transformative introduction

Of FHI 360’s findings, there are three key takeaways we would like to highlight:

1.  Promoting microbicides to all women, not just most at risk populations, will be important to avoid stigmatizing the product. People in both countries cautioned against promoting this HIV prevention method as a niche product for specific populations, fearing that targeted promotion of microbicides might stigmatize the method and lead to microbicide rejection by the populations who could benefit from it the most.

2.  Balancing women’s autonomy and male partner engagement in microbicide introduction is crucial. Women have the right to choose whether they inform their partners of their microbicide use, and health providers need to support women in making the decision that is appropriate for them. At the same time, educating men about microbicides may help increase acceptability and adherence and foster couples’ communication about sex and HIV protection. Microbicide introduction programs must take care to position women as the gatekeepers to their male partner’s involvement.

3.  Sex sells. Many believed that microbicide promotion should focus on sexual benefit and pleasure in order to increase its appeal. By highlighting these positive aspects of the gel, which were identified throughout earlier microbicide trials, people may be more likely to adopt this HIV prevention method.

In Sub-Saharan Africa, women’s access to sexual and reproductive health services is key to protecting their health and preventing HIV infection / Lisa Marie Albert

In Sub-Saharan Africa, women’s access to sexual and reproductive health services is key to protecting their health and preventing HIV infection. / Lisa Marie Albert

FHI 360’s gender analyses filled critical gaps in understanding that will enable public health practitioners to introduce this HIV-prevention method most successfully. As USAID and PEPFAR move closer to creating an AIDS-free generation, we recognize that gender analyses are a vital practice in order to better understand the communities with which we engage, strengthen the impact of our programs, and empower women and girls to protect their health and achieve their fullest potential.

ABOUT THE AUTHOR

Celia Karp is a public affairs intern in the Global Health Fellows Program II working in USAID’s Office of HIV/AIDS. Follow her @celkarp

Five Takeaways from AIDS 2014

Ten thousand miles away from Washington, D.C., global health colleagues from nearly 200 countries gathered at this year’s International AIDS Society Conference, AIDS 2014, in Melbourne, Australia. This conference, dedicated to ending HIV and AIDS worldwide, allowed researchers, activists and advocates to share their latest scientific findings and deliver thought provoking presentations on challenges the AIDS community faces. With a renewed commitment to ending the AIDS epidemic, AIDS 2014 provided its attendees and the greater AIDS community with an opportunity to learn from one another and strengthen our AIDS response efforts worldwide.

Here are my five key take aways from the conference:

Signs highlighting the 2014 International AIDS Society Conference on Princes Bridge in Melbourne, Australia. /  International AIDS Society/Steve Forrest

Signs highlighting the 2014 International AIDS Society Conference on Princes Bridge in Melbourne, Australia. / International AIDS Society/Steve Forrest

1.    UNAIDS announced its goal to end AIDS in cities by 2030. In order to achieve this monumental objective and create an AIDS-free generation, HIV and AIDS programs worldwide will need to coordinate their efforts to reduce new infections, stigma and discrimination effectively. Two of the objectives UNAIDS outlined in this goal include having 90 percent of people with HIV diagnosed and 90 percent of diagnosed people on treatment. Although it is an ambitious goal, it is achievable through hard work and collaboration among international researchers, AIDS experts and those working on the ground to fight this disease.

 International AIDS researcher Salim Abdool Karim of South Africa gives his speech 'State of the Art Epidemiology and Access'. / International AIDS Society/Steve Forrest

International AIDS researcher Salim Abdool Karim of South Africa gives his speech ‘State of the Art Epidemiology and Access’ / International AIDS Society/Steve Forrest

2.    The AIDS epidemic can be contained. In the Monday plenary session Salim Abdool Karim, Director of Centre for the AIDS Programme of Research in South Africa, which conducted the CAPRISA 004 trial — which provided the first proof of concept that a vaginal microbicide made of tenofovir gel could help protect women against HIV infection when used appropriately — provided an excellent overview of the history and epidemiology of the HIV and AIDS epidemic (23:50). (The CAPRISA trial was funded in part by PEPFAR through USAID). For many of us who have been invested in the fight against HIV and AIDS since the 1980s, Abdool Karim’s presentation helped refocus our attention on the disease origins and understand how the global AIDS response has developed. One of the most interesting aspects of his presentation was modeling that showed how the AIDS pandemic could be contained. With this encouraging information and a thorough discussion of ongoing challenges in this endeavor, we were able to collectively envision the future of AIDS and the end of the epidemic.

Members of the Australian Sex Workers Association participate in The Official AIDS Mobilisation March to Federation Square. /  International AIDS Society/Steve Forrest

Members of the Australian Sex Workers Association participate in The Official AIDS Mobilisation March to Federation Square. / International AIDS Society/Steve Forrest

3.    Preventing key populations from becoming infected is critical. Much of the conference’s focus was on the prevention needs of key populations (men who have sex with men, sex workers, injecting drug users and transgender people), and on the use of treatment as prevention. But in his plenary talk on Tuesday (1:03:00) Mark Dybul, Director of the Global Fund, gave a very powerful presentation arguing that behavior cannot be overlooked. As Dybul explained, the future of the global response to AIDS will need to maintain a strong emphasis on behavior change practices in order to dramatically reduce the epidemic.

Former US president Bill Clinton meets with public and delegates at the aids 2014 conference in Melbourne after his speech about the future for the treatment and prevention of HIV and AIDS. / International AIDS Society/James Braund

Former US president Bill Clinton meets with public and delegates at the aids 2014 conference in Melbourne after his speech about the future for the treatment and prevention of HIV and AIDS. / International AIDS Society/James Braund

4.    “Treatment as Prevention” must be carefully defined. With concerns expressed about the stigmatization of this approach to the AIDS epidemic, Virginia Bond, social anthropologist at the London School of Hygiene and Tropical Medicine, highlighted the importance of rethinking how we communicate about the prevention aspects of treatment. We must be clear that the burden of preventing more infections is not solely placed on infected persons taking antiretrovirals.

People living with HIV or AIDS, including young children, join prominent AIDS researchers on the stage at AIDS 2014. /  International AIDS Society/Steve Forrest

People living with HIV or AIDS, including young children, join prominent AIDS researchers on the stage at AIDS 2014. / International AIDS Society/Steve Forrest

5.    The needs and complexities of pediatric HIV and AIDS must be prioritized. One of the most engaging sessions of the conference was the presentation on adolescents with HIV. This session highlighted the intersection of working with vulnerable children, pediatric AIDS and the challenges of being an adolescent that has been HIV-positive since birth. Three young people from Thailand, India and Rwanda shared stories of their diverse battles with HIV and the struggles they dealt with throughout their youth. All three lost their parents at an early age. All three are on antiretroviral therapy. For me, the key point of the session was the vital role played by community organizations, social protection and other services for vulnerable children. None of these three young people would have survived to tell their stories without this protection, further reminding us that the success of “Treatment as Prevention” may well rest on the shoulders of community organizations.

The AIDS conference this year was a bittersweet affair. The tragic loss of some of our most distinguished colleagues and advocates cast a long shadow over the event. It is a loss we will feel for many years to come. However, with our relentless dedication to creating an AIDS-free generation and a clear direction moving us forward to meet the needs of those affected by the virus, the HIV and AIDS community is focused like never before.

 

ABOUT THE AUTHOR

David Stanton is the Director of USAID’s Office of HIV/AIDS in the Bureau for Global Health.

Can Private Financing Answer Uganda’s Health Care Woes?

Early this year, the U.S. and Swedish ambassadors went on a joint site visit to Rhona Medical Center, a medium-sized health clinic in Kampala. Site visits by the U.S. ambassador are not uncommon in Uganda where the health sector makes up the lion’s share of the aid budget. But this joint visit was unusual because it was to a private health facility that a year ago had received a loan co-guaranteed by USAID and the Swedish International Development Agency (SIDA).

Uganda’s adoption of the Anti-Homosexuality Act in February this year and the Ugandan president’s dismissal of the value of the U.S. Government’s development assistance to the country has prompted a review of our 50-year-long efforts in Uganda. In his February 24 speech, after signing the anti-homosexuality bill into law, Uganda’s President Yoweri Museveni stressed, “Uganda is a rich country that does not need aid, because aid is in itself a problem…”

Indeed, Uganda has made much smaller gains in key health indicators than its neighbors despite receiving larger aid inflows per capita, amounting to three quarters of all public health spending. I have spent some of my last three years at post pondering how we might be effective in improving the health of Ugandans when, despite the critical support provided by USAID and our implementing partners, the government fails to adequately enforce accountability and performance in the public health system. Uganda has had nominally free health care since 2001, yet a recent World Bank survey found that 51 percent of public sector health workers were absent from their posts and drug stock-outs also remain a problem.

An obvious answer to me was to invest in the emerging private sector, rather than continuing to unsustainably prop-up the public system. While USAID continues to support the public sector to ensure that the poorest Ugandans continue to access vital health care services, we can also ensure that people have additional health service options outside of the public sector, even when those options require payment. By distributing our aid across the public and private sectors, we hoped to continue to reach the poorest Ugandans while also helping increase the quality of health services through private sector development.

A nurse works in southwest Uganda's Kabwohe Clinical Research Center, a facility that received a $35,000 loan guaranteed through USAID's Development Credit Authority, and was able to hire more staff and provide life saving AIDS treatment to 4600 patients as a result. / USAID, Morgana Wingard

A nurse works in southwest Uganda’s Kabwohe Clinical Research Center, a facility that received a $35,000 loan guaranteed through USAID’s Development Credit Authority, and was able to hire more staff and provide life saving AIDS treatment to 4600 patients as a result. / USAID, Morgana Wingard

Over the last three years, with invaluable support from USAID’s Development Credit Authority, USAID/Uganda has built a portfolio of risk-sharing guarantees with local banks to open $10 million in private lending for Uganda’s health sector, at a cost of only $315,000 to USAID. The financing was made available for everything in the health sector from small drug shops to hospitals in Kampala, with an emphasis on facilities that serve rural areas – a segment that banks previously considered too high-risk to qualify for commercial loans.

Thanks to the risk-mitigating guarantees, private clinics can now access commercial loans to purchase medical equipment and expand their facilities to serve more clients. The results so far are impressive – Centenary Bank has utilized 50 percent of a five-year guarantee in a little over a year, reflecting the pent-up demand for credit. One of its loans – of around $25,000 – went to Rhona Medical Center and was used to purchase a dental x-ray, a scanning machine, a clinical chemistry machine, a hematology analyzer and six desktop computers.

Accompanying the U.S. and Swedish ambassadors on this site visit, Rhona’s director, Dr. Edward Bemera, shared with us that the clinic was able to get much better terms on its loan thanks to the USAID guarantee facility.

Along with the new medical equipment, he used his loan to hire additional nurses and to make renovations to the facility. As a result, the Medical Center’s revenues more than doubled, and the number of clients receiving better services quadrupled.

Dr. Bemera explains Amb. DeLisi, Amb. Andersson and the rest of the team about how he used the loan to scale up activities at his clinic.

Dr. Bemera explains to Amb. DeLisi, Amb. Andersson and the rest of the team about how he used the USAID-backed loan to scale up activities at his clinic. / USAID, Roberta Rossi

The contribution of the private health sector will grow significantly in years to come as banks realize that this segment is credit-worthy. This is evidenced by the fact that there have been no defaults to date under the guarantee. Increased competition will gradually reduce prices for patients, making private health care more affordable and of better quality.

USAID/Uganda has embraced the value of this private partnerships approach in other areas of our work. For example, since girls’ secondary enrollment is a strong predictor of improved maternal and child health outcomes, we are about to launch a new loan guarantee for girls’ school fee loans, that will be managed as part of our Orphans and Vulnerable Children program.

For me, to be given the opportunity to champion innovative approaches to development, and to see those translated into tangible results is a dream come true.

 

ABOUT THE AUTHOR

Daryl Martyris is a Health Development Officer in USAID Uganda’s Office of Health, HIV/AIDS and Education.

Global Leadership, Collaboration Aligned in the Fight Against Tuberculosis

Tuberculosis preys on the urban poor. ​​In the photo, the family of Rehmat Shek deals with the disease in Rafik Nagar slum in India. Global leaders in the fight against TB hope to end the epidemic by 2035.

Tuberculosis preys on the urban poor. ​​In the photo, the family of Rehmat Shek deals with the disease in Rafik Nagar slum in India. Global leaders in the fight against TB hope to end the epidemic by 2035. David Rochkind / WHO

With approval of the post-2015 global tuberculosis strategy by the World Health Assembly, the global community stands united as we work toward ambitious new targets for 2025 and 2035 to end the global TB epidemic. As we look to the future, it is important to evaluate the current global response to the epidemic so we may develop an effective and coordinated approach going forward. Major investments in TB by high-burden countries, the U.S. Government, the Global Fund (GF), the World Health Organization (WHO) and others have led to impressive progress and shown the potential for future impact. Promising new tools are now finally available, with others in the pipeline, and governments, donors and partners are allied around a new strategy with refocused resources.

Where are we succeeding?

TB kills three people a minute, is a security threat to the world, and puts health care personnel and poor and marginalized populations at risk around the globe. Yet, TB treatment is one of the best buys in global health – the disease is almost always curable (unless resistant to major drugs) with inexpensive medications and low-cost delivery approaches, and has been considered in various assessments as one of the most cost-effective public health interventions. New and cheaper models to diagnose and treat multidrug-resistant TB are being scaled up in many high-burden countries and the cost of second line drug treatment regimens to cure TB have decreased by 32 percent, thanks to efforts by the Global Drug Facility (GDF).

In the space of 17 years since the implementation of a new standard approach to control TB, 56 million people across the globe have been successfully diagnosed, treated and cared for, and WHO estimates that 22 million lives have been saved by using comprehensive and proven approaches to TB care[U1] , compared to what would have occurred if previous standards continued. These milestones reflect the ongoing commitment of governments and the global community to transform the fight against TB and work toward elimination of this major public health problem and global threat. Since 1990, TB deaths have declined by 45 percent and TB prevalence has declined by 37 percent globally. The world is now on track to meet the MDG target of 50 percent reduction in mortality by 2015.

Key ingredients to success and readiness to face challenges:

1.  Proven strategies, collaboration and leadership. Coordination and harmonization of efforts were the key to high effectiveness and success. The national programs take the lead in establishing policies aligned with international best practice and ensuring their implementation within primary care services. A clearly budgeted national strategic plan is fundamental to optimizing the use of resources and identifying gaps. Technical partners and financiers support the plan in a uniform manner. Supporting this model, the U.S. Government is the largest bilateral donor for TB and USAID serves as the lead agency for international TB control. Without this current systematic response, we will miss out on opportunities with endemic country partners and governments. Most importantly, progress in saving lives will be slowed.

 2.  Boots on the ground.  The U.S. bilateral program works directly with local governments and ministries of health to develop country-owned approaches and build national capacity so countries can successfully implement their TB care and treatment programs. This close collaboration with ministries of health has resulted in faster detection and treatment of TB; scaled-up prevention and treatment of multi-drug resistant TB (MDR-TB); expanded coverage for interventions for TB/HIV; and improvements in the health system. This approach also improves the strategic use of GF and domestic resources as well as the quality of TB programs.

3.  Resource Allocation and Realignment. The Global Fund and the United States both recently realigned their resources to further strengthen the next phase of TB response and focus where the need is greatest to sustain value and resolve outstanding challenges. Among the concerns faced by countries are ability to match external financing, coverage of services, and the MDR-TB and TB/HIV burdens. Since 2009, the U.S. Government has allocated almost $3.3 billion towards implementation of TB programs in high-burden countries with over $600 million in FY13 (see table below). The U.S. bilateral program, led by USAID, is focused on countries with the greatest TB burden and need. The current 27 USAID-supported countries carry almost 70 percent of the world’s annual TB cases, not including China. Through its new funding model, the GF has also redefined support for TB.  Twenty-four of the eligible countries account for 79 percent of the world’s annual TB cases (not including China) and have been allocated almost 60 percent of the total of TB funds. The GF has increased TB resources from 16 percent to 18 percent of all funds for 2014-2017.

Funding Stream

2009 (USD M)

2010 (USD M)

2011 (USD M)

2012 (USD M)

2013 (USD M)

2014 (USD M)

USAID TB Bilateral[1]

176

249

238

256

232

244

PEPFAR TB/HIV[2]

150

137

152

132

132*

132*

USG Portion of GF TB Grants**[3]

129

172

145

166

242

213

Total TB funding for Country Implementation

455

558

535

554

606

589

*Assumed flat-line budget numbers based on the public FY12 figures.

**This represents 1/3 of the total TB allocations to countries in each year. It is the actually disbursement of TB funds for in this year. Note, the increase in 2013 is due to a large increase in distribution of funds for India.

 4.  Research and Innovation. After decades of using outdated tools that limited achievements, the TB community now has newer rapid molecular diagnostics, modernized approaches and new medicines already available for the treatment of MDR-TB. With the introduction of an innovative diagnostic test, Xpert, countries can implement faster and better detection of TB and drug resistant TB.  Further, the price buy-down of this new technology by the U.S. Government, the Bill & Melinda Gates Foundation and UNITAID has ensured rapid adoption and implementation of Xpert by over 100 low- and middle-income countries. In addition, new TB treatment regimens that use novel drugs and will bring renewed hope for TB patients are under study, including the expanded STREAM study (a 9 month MDR-TB regimen with a new drug) and the PaMZ study that is evaluating the efficacy, safety and tolerability of a treatment regimen for both drug susceptible and drug-resistant TB. Lastly, the work of the Global Drug Facility, supported by the U.S. Government, has ensured that quality, affordable second line drugs are available as countries scale-up MDR-TB treatment. USAID has collaborated with the Global Drug Facility and other partners to support over 40 manufacturers to improve the quality and availability of second-line drugs and make MDR-TB treatment more affordable.

A doctor visits a patient at the Group of TB Hospitals in Mumbai during the daily rounds. / David Rochkind, WHO

A doctor visits a patient at the Group of TB Hospitals in Mumbai during the daily rounds. / David Rochkind, WHO

Future Strategic direction: 

The post-2015 Global TB Strategy approved at the World Health Assembly in May 2014 focuses on three pillars including: patient centered care and prevention; bold policies and supportive systems; and intensified research and innovation. The U.S. Government  is developing a new long-term strategy that will align with the recently approved WHO post-2015 strategy to Reach, Cure, and Prevent.  The U.S. Government commits to Reach every person with TB, Cure those in need of treatment and Prevent new infections and spread of the disease. To reach these goals, the different U.S. agencies involved in TB treatment and control will need to leverage their collective strengths and continue to collaborate through existing processes such as a common strategy and joint projects, defined roles, joint reporting and regular coordination.

Filling the Funding Gap – Despite recent wins and progress against TB, the current funding gap of $2 billion per year remains a fundamental challenge to face. The availability of this funding would result in major benefits for a huge number of people. As mentioned in the recent February Lancet commentary, domestic resources should continue to be mobilized for long-term and effective TB care and treatment. The international community must continue to bolster national efforts as well as support the development of global, common goods such as research, affordable and quality TB commodities, and support for innovations and new research. Global partners should help mobilize resources to fill gaps in TB care, including crowding in partner country financing and identifying new partners.

Building a multi-sectoral response – Tuberculosis provides a perfect example of how health security is intimately linked to social and economic development. Ending extreme poverty is critical to global progress on TB as are overarching efforts to achieve universal health coverage. A person’s health status is intimately entwined with underlying poverty, political and social stability, economic growth, food security, education and gender equality.  Development agencies such as USAID, along with U.N. agencies, NGOs and civil society, need to play their part in building cross-sectoral links. Together, we must work in harmony to reduce the social determinants of TB and to reach and serve the poorest and most vulnerable.

Research – The post-2015 goals will be difficult to achieve without a more robust research pipeline. This will require additional funding for research to ensure that the top priorities for innovation are a point-of-care diagnostic, better and shorter regimens and a new vaccine.  New tools for improving approaches at the country level will be necessary to optimize results.

The global fight against TB remains fragile, given resource constraints. Yet, promising new tools are now available, with others in the pipeline, and donors and partners are allied around a new strategy with refocused resources. We are now at a crossroads between ending the TB epidemic by 2035 and witnessing millions more TB deaths. But with continued consultation, coordination and leadership, we believe we will end the epidemic.

 


[1] USAID CBJ budget figures for each year

[2]  PEPFAR FY13 CBJ: http://www.pepfar.gov/documents/organization/222642.pdf

[3] GF website: http://portfolio.theglobalfund.org/en/Home/Index

[U1]Footnote that this is WHO data.

 

ABOUT THE AUTHOR

Dr. Ariel Pablos-Mendez is the Assistant Administrator for Global Health at USAID
Dr. Mario Raviglione is the Director of Global TB Programme for WHO
Dr. Dyah Erti Mustikawati is the NTP Manager at MOH/Indonesia
Mr. Lerole David Mametja is the Chief Director for TB Control and Management at MOH/South Africa

 

10 Reasons Vaccines are the Best Protector of Human Life

A young boy receives an oral polio vaccination at a USAID -funded medical clinic on July 13, 2010 in Petionville, Haiti.  In 2011 in Haiti, the U.S. Government  vaccinated nearly 157,000 children under the age of one for routine childhood diseases and provided more than 350,000 antenatal care visits and more than 131,000 post-partum/newborn care visits.  The United States is providing access to health services for 50 percent of the people of Haiti.  Kendra Helmer/USAID

A young boy receives an oral polio vaccination at a USAID-funded medical clinic on July 13, 2010 in Petionville, Haiti. In 2011 in Haiti, the U.S. Government vaccinated nearly 157,000 children under the age of 1 for routine childhood diseases. / Kendra Helmer, USAID

Immunization is one of the most powerful health interventions ever introduced. Every year, the World Health Organization estimates, vaccines save between 2 and 3 million children from killers such as polio, measles, pneumonia, and rotavirus diarrhea.

To mark World Immunization Week, USAID partner PATH is reporting on the lifesaving potential of vaccines against four illnesses that kill more than 2 million young children a year: malaria, pneumonia, rotavirus, and Japanese encephalitis. Here, Dr. John Boslego, director of PATH’s Vaccine Development Program, lists the top 10 ways vaccines make a difference for children and for global health. This post originally appeared on PATH.

No. 10: Vaccines lower the risk of getting other diseases.

Contracting some diseases can make getting other ones easier. For example, being sick with influenza can make you more vulnerable to pneumonia caused by other organisms. The best way to avoid coinfections is to prevent the initial infection through vaccination.

Here a Nepalese boy demonstrates the water flow of a USAID-built electric tube well used for irrigation in the Terai region of Nepal. Patrick D Smith/USAID

A Nepalese boy demonstrates the water flow of a USAID-built electric tube well used for irrigation in the Terai region of Nepal. / Patrick D Smith, USAID

No. 9: They keep people healthier longer.

Some vaccines protect people for a limited time and require booster doses; others protect for a lifetime. Either way, vaccinated people are much safer from many serious diseases than people who haven’t been vaccinated, both in the short and long term.

As part of a USAID-supported polio initiative, a vaccinator in the Democratic Republic of Congo (DRC) administers the oral polio vaccine March 23 in the Commune of Ndjili, Kinshasa. On that day, Minister of Health, Victor Makwenge Kaput officially launched a vaccination campaign against the wild polio virus in the capital city. USAID/A. Mukeba

As part of a USAID-supported polio initiative, a vaccinator in the Democratic Republic of Congo administers the oral polio vaccine in the Commune of Ndjili, Kinshasa. / USAID, A. Mukeba

No. 8: They are relatively easy to deliver.

Through national immunization programs and mass vaccination campaigns, vaccines can be delivered quickly to large numbers of people, providing widespread protection. Thanks to creative strategies, delivery in even the remotest parts of the world is becoming easier.

USAID and the Medical Relief International Charity (Merlin) support cholera treatment centers in Goma, Democratic Republic of Congo.  Pictured is a young child suffering from cholera and receiving food aid from the Agency.  /  Frederic Courbet

USAID and the Medical Relief International Charity (Merlin) support cholera treatment centers in Goma, Democratic Republic of Congo. Pictured is a young child suffering from cholera and receiving food aid from the Agency. / Frederic Courbet

No. 7: They prevent disease where medical care isn’t an option.

Too many children die because high-quality care is unavailable. When a child in poverty gets sick, medical care could be inadequate or several days’ travel away. Stopping disease before it starts could be that child’s only lifeline.

Solar lights funded by OTI in Cap Haitien and en route to Caracol, Haiti, on Oct. 19, 2012.. / Kendra Helmer/USAID

Solar lights funded by USAID help children read at night in Cap Haitien. Haiti, on Oct. 19, 2012. / Kendra Helmer, USAID

No. 6: They play well with other interventions.

Vaccines complement other global health tools. We’re seeing this with the integrated strategy to protect, prevent, and treat pneumonia and diarrhea through basic sanitation, safe drinking water, hand-washing, nutrition, antibiotics, breastfeeding, clean cook stoves, antibiotics, zinc, oral rehydration solution, and vaccines. Leveraging these tools across diseases could save the lives of over 2 million children by 2015.

This photo took third place in the FrontLines photo contest. Maamohelang  Hlaha tenderly kisses her young son Rebone. An HIV-positive mother of four, Hlaha’s  village is inaccessible by vehicles and a three-hour hike from the nearest health clinic.  She receives HIV treatment through the Riders for Health program, which is funded  by USAID and run by the Elizabeth Glaser Pediatric AIDS Foundation. As part of the  program, pony riders and motorcycle riders transport blood tests, drugs and supplies to  Lesotho’s remote mountain health clinics. The system allows people to receive HIV test  results sooner, access life-saving drugs and ensure an uninterrupted supply of medication.  Rebone, whose name means “we have witnessed,” was born HIV-free in August 2008. / Reverie Zurba, USAID/South Africa

A mother of four who receives HIV treatment through a USAID-funded program tenderly kisses her young son in South Africa. Thanks to the treatment, her son was born HIV-free in August 2008. / Reverie Zurba, USAID

No. 5: They continue to evolve.

Tackling unmet health needs requires us to continue to pursue the next generation of better and more affordable vaccines. Candidates like RTS,S for malaria and ROTAVAC® for the leading cause of severe diarrhea—rotavirus—are two examples of innovative technologies on the horizon that give families and communities more cause for hope.

This photo was chosen as a finalist in the FrontLines photo contest. These schoolchildren in Aqaba, Jordan, are beneficiaries of the Jordan Schools Program and  Education Reform Support Program. Both of these projects are funded by USAID to  support the Jordanian Ministry of Education’s reform efforts in improving the quality of education in the country. March 2011. / Jill Meeks, Creative Associates International

These schoolchildren in Aqaba, Jordan, are beneficiaries the Jordan Schools Program and Education Reform Support Program. Both  are funded by USAID to support Jordan’s efforts to improve the quality of education in the country.  / Jill Meeks, Creative Associates International

No. 4:  They indirectly protect loved ones and communities.

For many diseases, immunizing a significant portion of a population can break the chain of transmission and actually protect unvaccinated people—a bonus effect called herd immunity. The trick is immunizing enough people to ensure that transmission can’t gather momentum.

A little girl in Tajikistan eats mashed potatoes with greens, which her mother prepared for her. Over 5,000 Tajik children under 5 years old tasted new foods such as pancakes ("blini") with cottage cheese and vegetable salads that their mothers prepared for them after a training. / USAID

A little girl in Tajikistan eats mashed potatoes with greens, which her mother prepared for her. Over 5,000 Tajik children under 5 years old tasted new foods such as pancakes (“blini”) with cottage cheese and vegetable salads that their mothers prepared for them after a USAID-supported nutrition training. / USAID

No 3: They are safe and effective.

Vaccines are among the safest products in medicine and undergo rigorous testing to ensure they work and are safe. Their benefits far outweigh their risks (which are minimal), especially when compared to the dire consequences of the diseases they prevent. Vaccines can take some pretty terrible diseases entirely or nearly out of the picture, too. That’s the case with smallpox and polio, and others will follow.

School girls in Sana’a gather for their lesson. Since many girls in Yemen do not attend primary school or graduate from it, recent USAID-backed measures have ensured all girls a right to attend school and increase literacy. / Malak Shaher, USAID/YMEP

School girls in Sana’a gather for their lesson. Since many girls in Yemen do not attend primary school or graduate from it, recent USAID-backed measures have ensured all girls a right to attend school and increase literacy. / Clinton Doggett, USAID

No. 2:  They are a public health best buy.

Preventing disease is less expensive than treating severe illness, and vaccines are the most cost-effective prevention option out there. Less disease frees up health care resources and saves on medical expenditures. Healthier children also do better developmentally, especially in school, and give parents more time to be productive at home and at work.

This image captured top honors in the FrontLines photo contest. These rural schoolchildren participate in the USAID-funded Southern Sudan Interactive Radio Instruction project, which uses radio to broadcast interactive student lessons. The lessons, based on Southern Sudan’s primary school syllabus, complement classroom instruction in literacy, English, mathematics, and life skills for grades one through four. July 2010. / Karl Grobl, Education Development Center Inc.

These rural schoolchildren participate in the USAID-funded Southern Sudan Interactive Radio Instruction project, which uses radio to broadcast interactive student lessons. The lessons, based on Southern Sudan’s primary school syllabus, complement classroom instruction in literacy, English, mathematics, and life skills for grades one through four. July 2010. / Karl Grobl, Education Development Center Inc.

No. 1:  They save children’s lives.

Roughly 2 to 3 million per year, in fact. In short, vaccines enable more children to see their 5th birthdays, let alone adulthood. That’s reason enough to top my list.

Video: Ghanaian Town Takes on Malaria

A couple in Ghana sits with an insecticide spray technician. / Erin Schiavone, Abt Associates

A couple in Ghana sits with an insecticide spray technician. / Erin Schiavone, Abt Associates

When it’s a buggy summer day, Americans may dust off the old bottle of Off, or light a citronella candle. Here, a mosquito bite is a nuisance. In many parts of the world, it’s a deadly killer.

 In 2012, there were still 207 million cases of malaria and over 600,000 deaths –  three quarters were children under 5. Approximately half of the world’s population is still at risk of malaria.

What choices do people in malarial zones have to protect themselves from this flying terror? And what are we doing to help?

 One of the most effective methods being supported by the U.S. President’s Malaria Initiative (PMI) around the world is spraying homes in the areas where the mosquitos live with an insecticide.

According to the World Health Organization an estimated 3.3 million lives were saved as a result of the scale-up of malaria control interventions over the last decade. Over the same period, malaria mortality rates in African children were reduced by more than half.

This delivers a massive, concerted blow to the mosquito population. In order to have an impact, indoor residual spraying, as it is called, must be carried out in least 80 percent of the homes in malaria-prone areas, use an effective insecticide and be executed by a well-trained workforce.

In Ghana, the entire population of 25 million is at risk for malaria; indoor residual spraying is helping protect families from this deadly disease. But it doesn’t happen on its own. A network of “social mobilizers” help communities realize the benefits of spraying, and encourage other health-improving behavior as well.

Bertha Moisob a passionate public health advocate working on a PMI-funded program in Ghana says this:

“My hope for the future is to see that reduced malaria burden.. Children are healthy, pregnant women delivery safely…”

Watch this video on how Bertha and her community are mobilizing against malaria

Full Speed Ahead on Malaria

 

Rear Admiral Tim Ziemer / Platon

Rear Admiral Tim Ziemer / Platon

Today, the greatest success story in global health is anchored by a continent once known mostly for famine and war. Many countries in sub-Saharan Africa are making unprecedented gains in child survival and reducing the devastating burden of malaria—a disease carried by mosquitoes and a major killer of children.

According to the World Health Organization an estimated 3.3 million lives were saved as a result of the scale-up of malaria control interventions over the last decade. Over the same period, malaria mortality rates in African children were reduced by an estimated 54 percent.

Most Americans are unaware of the devastating impact of malaria. But the insidious disease, a root cause and consequence of poverty, conspire against young children and pregnant women. The anopheles mosquito is a serial killer — a flying syringe that injects parasites during nightly blood meals.

Just a decade ago, the malaria story was one of despair across wide swathes of the African continent, killing more than 1 million people, and burdening health systems — up to 45 percent of all hospital admissions were caused by malaria.

A mother and child under a malaria-fighting bednet. /  Maggie Hallahan

A mother and child under a malaria-fighting bednet. / Maggie Hallahan

I was raised in Asia, and was infected by malaria as a child. Although malaria no longer threatens boys and girls in the United States, across Africa and in parts of Asia, it is still a frightening and literally gut-wrenching fact of life. Each case can be a struggle for survival.

Because malaria remains one of the foremost health problems on the African continent it is vital to test all children with fever and treat those who test positive for malaria as well as provide appropriate treatment to those with non-malaria fevers. With many people living great distances from or lacking transport to health facilities, community health workers are often the first and only link to providing health services essential to child and maternal health.

Community health works, like these in Madagascar, are often the front lines of defense against malaria. Photo Credit: Maggie Hallahan

Community health works, like these in Madagascar, are often the front lines of defense against malaria. / Maggie Hallahan

Thanks in part to American investments made through the U.S. President’s Malaria Initiative (PMI), led by the U.S. Agency for International Development (USAID) and implemented together with the Centers for Disease Control and Prevention (CDC), 61,000 front-line health workers were trained on how to treat malaria cases. Many were also trained to diagnose and treat the other main causes of childhood illness, diarrhea and pneumonia.

In the past year, Americans, through PMI, protected over 45 million people with a prevention measure (insecticide-treated nets and/or indoor residual spraying), as well as procured more than 48 million antimalarial treatments and more than 51 million rapid diagnostic tests.

In Madagascar, people line up to receive insecticide-treated bednets and treatment. Photo Credit: Maggie Hallahan

In Madagascar, people line up to receive insecticide-treated bednets and treatment. / Maggie Hallahan

Success is a triumph of partnership – the initiative was launched by President George W. Bush, and expanded under President Barack Obama. We have benefited from strong bipartisan support in the Senate and House. And with host country government leadership, donors, partners like the Peace Corps, and countless groups like Lutheran World Relief, Catholic Relief Services, Malaria No More and Nothing But Nets – we are taking malaria and other public health interventions the last critical mile, to communities in the most remote parts of malaria endemic Africa.

Commemorating World Health Day

In his State of the Union address, President Obama called upon our nation to join with the world in ending extreme poverty in the next two decades. Today, we have new tools that enable us to achieve a goal that was simply unimaginable in the past: the eradication of extreme poverty and its most devastating corollaries, including widespread hunger and preventable child and maternal death.

Preventing and controlling vector-borne diseases, diseases carried by insects, ticks and small animals, is central to achieving President Obama’s vision of ending extreme poverty. On World Health Day, commemorated each year on April 7, the World Health Organization (WHO) highlights actions we can all take to protect ourselves from the serious diseases that these “vectors” can cause.

Children wash their hands in Ghana, where USAID supports prevention and treatment of trachoma, a blinding eye disease.  International Trachoma Initiative (ITI) ..

Children wash their hands in Ghana, where USAID supports prevention and treatment of trachoma, a blinding eye disease.
International Trachoma Initiative (ITI) ..

More than half of the world’s population is at risk from vector-borne diseases, such as malaria, dengue fever and neglected tropical diseases. The most commonly known vectors include mosquitoes, sandflies, bugs, ticks and snails, which are responsible for transmitting a wide range of parasites and pathogens contributing to deadly diseases.

Senegal: Demonstrating the proper use of ITNs in Senegal. Photo Credit: Maggie Hallahan

Senegal: Demonstrating the proper use of ITNs in Senegal. Photo Credit: Maggie Hallahan

Below, we highlight solutions to combat extreme poverty and vector-borne diseases.

Solutions

  • In this scene-setter, USAID Administrator Rajiv Shah explains how USAID and its partners have embraced the challenge of creating a world without extreme poverty.
  • In “A Call to Action to End Extreme Poverty,” Alex Thier and Ilyse Stempler discuss how USAID and its partners are adopting an integrated, holistic approach that capitalizes on their collective expertise. They share past successes in addressing extreme poverty and introduce some new ideas to finish the job.
  • In “Your Voice,” a continuing FrontLines feature, Adm. Tim Ziemer, U.S. Global Malaria Coordinator, shares his perspective on leading a major presidential initiative to end deaths from malaria
  • Katherine Sanchez profiles Ghana’s efforts to become the first country in sub-Saharan Africa to eliminate trachoma, the world’s leading cause of preventable blindness.
  • A Yumbe survey team learns how to use electronic tablets to collect data on trachoma.  Christine Ninsiima

    A Yumbe survey team learns how to use electronic tablets to collect data on trachoma.
    Christine Ninsiima

    And in “Trachoma vs. Technology,” Phil Downs and Scott Torres uncover efforts to capture and analyze data quickly on mobile electronic tablets in rural Uganda. This approach is transforming the battle against an ancient eye disease, for which timely treatment can prevent blindness.

  • Students prepare to take part in a mapping survey at Pav Primary School in Rattanakiri.  Credit: Chan Vitharin ..

    Students prepare to take part in a mapping survey at Pav Primary School in Rattanakiri.
    Credit: Chan Vitharin ..

    In “Wiping Snail Fever Off Cambodia’s Map – by Drawing It On,” Sokhon Sea delves into an effort to enlist many, including school children, on a mission to wipe out the infection that can lead to debilitating illness and malnutrition and cognitive difficulties in children.

  • Finally, Ann Varghese and Chris Glass explore a unique drug-shoe combination that could stomp out two debilitating diseases endemic to Haiti and how wearing new sneakers kicks up that protection even more by creating a barrier between parasites and kids’ feet.

 

Creating an AIDS-Free Generation through Science and Technology

Last year, the United States government provided testing and counseling for more than 57 million people through the President’s Emergency Plan for AIDS Relief (PEPFAR). The program enrolled more than four million men in voluntary medical circumcision programs and supported more than five million orphans and vulnerable children in countries with some of the highest rates of HIV and AIDS. These are just a few of the remarkable achievements that PEPFAR has made over the past decade—a small testament to the hard work of so many who are committed to and work tirelessly every day to achieve an AIDS-free generation. These great achievements, however, would not be possible without inspiring advances in science and technology.

Women can use this ARV-based vaginal gel to protect themselves against HIV. International Partnership for Microbicides

Credit: International Partnership for Microbicides

For the first time, the U.S. Agency for International Development (USAID) – through its Office of Science and Technology - has created an awards program that embodies the agency’s commitment to supporting innovation in science and technology applications. The Pioneers Prize pays tribute to technological advances that offer innovative solutions to critical issues facing global development. By utilizing science, technology and innovation, USAID is working toward its mission to end extreme poverty and promote resilient democratic societies.

As a key implementer of PEPFAR, USAID’s work in HIV and AIDS was well-recognized with this year’s Pioneer Prizes. Awarded three grand prizes, the Office of HIV/AIDS, along with its partners, has been able to share the transformative nature of its work with the rest of the global health and development community.

Among the grand prize winners is the Delivery Team Topping Up (DTTU) program, which uses vendor-managed inventory principles to “top up” supplies, such as condoms and HIV test kits, at public health facilities. To date, the program has serviced 1,800 clinics in Zimbabwe.

The PLACE Method, also a recipient, applies new technologies in HIV and STI testing, spatial mapping, epidemiologic theory and empiric evidence to address the problem of obtaining valid information that can prevent the spread of infections in sex workers and injecting drug users. It targets geographic areas with high rates of infection and the venues where people at high-risk meet. It then uses low-cost GPS receivers and Google Earth to identify gaps in prevention programs.

Finally, Tenofovir gel, a vaginally applied antiretroviral microbicide used to prevent HIV infection, gives women an alternative method to keep themselves safe during unprotected sex. Tested in the CAPRISA 004 trial, Tenofovir gel reduced HIV acquisition by an estimated 39 percent overall and by 54 percent in women with high gel adherence. While still awaiting the results of an ongoing confirmatory trial, regulatory approval, and scale-up, the CAPRISA 004 trial demonstrated for the first time that a microbicide has the potential to drastically reduce HIV infection for women.

With these awarded innovations, it is clear that USAID’s work toward HIV and AIDS prevention through PEPFAR remains essential to achieving our mission of ending extreme poverty. With the commitment, innovative spirit, creativity and hard work of our partners, USAID is continuously using science and technology in unprecedented ways to make great strides toward an AIDS-free generation.

Let’s Stand Up For Inclusion, Not Exclusion

The stigma and discrimination faced by people living with HIV/AIDS continues to be a roadblock for access to critical prevention and care. Yet every day I see significant steps that are being taken to overcome this obstacle, especially efforts led by USAID.

I was invited to speak at the USAID-funded Panos Caribbean media launch of its latest publication, “Speaking Out! Voices of Jamaican MSM.” This publication is a compilation of oral testimonies from the men having sex with men (MSM) community in Jamaica and an important product by the Panos Caribbean/World Learning project which works to strengthen and improve the livelihoods of these men. Through this publication, Panos Caribbean develops public awareness about the issues affecting the MSM community and promotes through the media, tolerance and accountability for MSM who are impacted by HIV/AIDS.

Denise A. Herbol

Denise A. Herbol

The social complexities surrounding the MSM community in Jamaica is often polarizing to the public.  There is serious stigma attached to any activities by this community. This is compounded by the fact that HIV remains a complex issue among the most-at-risk populations in Jamaica, including the MSM community. Current statistics on HIV prevalence rates in Jamaica are 1.7% in the general population, or roughly 32,000 persons living with AIDS. Figures are significantly higher in a number of high risk groups: for the MSMs, the prevalence rate is 32%, which in many cases can be directly attributed to the stigma, discrimination and fear of violence or legal sanctions.

In an effort to achieve an AIDS-free generation, breaking down the barriers for all individuals is essential. With support from the President’s Emergency Plan for AIDS Relief (PEPFAR), USAID is allocating significant resources to reach populations most at risk for transmitting or becoming infected with HIV/AIDS. PEPFAR seeks to promote an enabling environment of supportive laws, regulations, policies and social norms in order to facilitate meaningful access to HIV services for these populations at both the facility- and community-level.

USAID, in partnership with Panos, is leading positive efforts to promote tolerance and accountability in response to HIV through constructive use of the media.  Panos continues to equip these men with effective tools to expand their voices and concerns so that they can be heard across Jamaica.

Progress will continue to be hampered until we include all people to achieve an AIDS-free generation.  Each of us must do our part to promote inclusivity, celebrate diversity, and eliminate stigma and dehumanizing stereotypes.

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