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Archives for Global Health

Digital Birth Control On Your iPhone

Just when you thought there was an application for everything, now you can download birth control to your smart phones. The ability to plan or prevent pregnancy is something most couples in developed nations take for granted. In poor countries where health systems are often weak and individuals can’t afford to see a health professional this luxury is wanted and needed, but not easily attained.

An estimated 200 million women wish they could plan for or prevent pregnancy because having more children poses a health risk to the woman or an economic challenge for the family.

The product, iCycleBeads, is now available at the iTunes store. It’s a natural birth control method that enables a woman to track her menstrual cycle and know if she is on a day when pregnancy is likely or not. Many women and couples prefer this method because it is:

  • More than 95% Effective
  • Side-Effect Free
  • Easy to Use
  • Inexpensive
  • Educational & Empowering

Since 1985 USAID has supported the use and development of natural family planning methods that give couples the tools they need to plan for the future health and stability of their families. It was a USAID-funded study that originally developed the science and methodology behind Cyclebeads which has helped couples in developing countries plan their families for decades.

This new trend towards digitizing birth control through smart phone applications or similar services offered on regular cell phones means more couples will have access to the family planning services they want.

CycleBeads is a color-coded string of beads that represents the days of a woman’s cycle and helps her use a natural family planning method called the Standard Days Method®. To use CycleBeads, a woman simply moves a ring over the beads to track each day of her cycle. The color of the beads lets her know whether she is on a day when pregnancy is likely or not and whether her cycle length is in the appropriate range for using this natural family planning method.

U.S. Responds to Cholera Outbreak in Haiti

Nancy Lindborg is the Assistant Administrator for the Bureau for Democracy, Conflict and Humanitarian Assistance. Photo Credit: USAID

Nancy Lindborg is the Assistant Administrator for the Bureau for Democracy, Conflict and Humanitarian Assistance. Photo Credit: USAID

Responding to disasters is never easy, and the cholera outbreak in Haiti is no exception.  The six-week-old outbreak has claimed the lives of more than 2,000 Haitians and infected 80,000 others.  Sadly, this illness will likely continue to spread for many months to come, and cholera will be present in Haiti for years.

Six weeks after joining USAID, I traveled to Haiti as part of the U.S. response to the cholera outbreak.  I saw the worst of it:  sick women and children, massive dehydration, and widespread fear.

I also saw signs of hope and reasons for the American people to be proud of our response to the outbreak.  The Haitian Government is leading the charge against cholera, and the U.S. Government is coordinating with the international community to deliver life-saving supplies, train Haitian medical staff, and monitor the outbreak.

United States government assistance to the cholera outbreak has been a swift, coordinated multi-agency effort.  We have collectively provided more than $21.5 million in assistance for the cholera outbreak in Haiti to date.  As cholera continues to spread, the U.S. Government is focusing on both the prevention of and treatment for the disease.

On the prevention side, USAID is supporting a nationwide messaging campaign to promote better hygiene practices and increase public awareness of prevention and treatment of the disease.  We are also training almost 7,500 community health workers and hygiene promoters across all 10 departments in Haiti.

Slideshow provided by Flickr. Click here for captions and high-resolution images

To further assist the Government of Haiti’s cholera prevention programs, USAID has already delivered or scheduled the delivery of much-needed cholera prevention supplies.  These include:

  • 30 metric tons of chlorine, which will provide nationwide treatment of Haiti’s  water utilities for three months
  • 15 million aquatabs, enough to help 750,000 people
  • Nearly 63,000 family hygiene kits, to benefit 345,000 people

As the numbers of cholera patients increases, we are also increasing our cholera treatment activities. U.S. government funding has established 27 cholera treatment facilities, and we are working to bring an additional 37 facilities online as soon as possible.

To further increase treatment capacity, USAID delivered 25 cholera treatment kits to Port-au-Prince last week.  These kits include items such as medical supplies, gloves, soap, and intravenous fluid, and the kits will help treat 10,000 moderate and severe cholera patients.  These cholera kits are being placed at critical sites in underserved and remote, rural areas in each of Haiti’s 10 departments.

USAID is also providing supplies to aid in the treatment of cholera.  The following supplies are already in country or planned for staggered arrival through the month of January:

  • 5.3 million ORS sachets, which will benefit an estimated 530,000 people
  • 600,000 liters of ringer’s lactate, which will benefit 75,000 patients
  • 2,000 cholera beds

NGOs, donors, and other members of the international community are also mobilizing to help curb the spread of this epidemic.  Tragically, it will be nearly impossible to fully stop the course of this epidemic.  The earthquake exacerbated Haiti’s weak sanitation systems and health infrastructure, making it particularly susceptible to disease outbreaks.  Cholera is also a new disease for Haitians, so their immune system is more vulnerable than those populations where cholera is endemic.

Our goal is first to ensure every Haitian receives information about how to prevent infection and how to recognize the early symptoms of cholera. Secondly, we are determined to reduce both fatalities and the number of severe cases that require hospitalization.  We’re already seeing progress.  Early in the outbreak, about 9 percent of hospitalized cholera cases were fatal.  In the latest reports from Haiti’s Ministry of Health, that figure is down to 3.5 percent.

To say 2010 was a challenging year for Haiti would be a brash understatement.   An earthquake, hurricane, and disease outbreak would test the mettle of any population, but Haitians are confronting these challenges head on, and they’re doing it with unprecedented resolve and tenacity.

One Man Can

There may be one major factor overlooked in the struggle for women’s rights: men. Skeptics are being won over by the preponderance of evidence proving that unless men are actively engaged in supporting the empowerment of women, progress will remain painfully slow and women will remain vulnerable to health threats, including gender-based violence.  While this may seem obvious, the findings demonstrate a need to incorporate educating males as a key function of women’s rights organizations and programs.

Years ago, women’s health activists fighting for limited resources believed involving men would take away from the women. Today, studies clearly show that is not the case, and activists now see men as playing a central role in achieving their goal.

Programs like USAID’s “One Man Can” focuses efforts on changing the attitudes of men to create an equitable balance of power, privilege, responsibilities and resources that men and women possess. These programs are proven more effective when men see the advantages for themselves, their partners, and children.

Traditionally, men are prone to take more risks with their health, are less likely to seek professional healthcare services, and often choose to remain emotionally distant from women and children.  These norms are detrimental for both men and women, and provide a poor example to children who then perpetuate this cycle.

Reaching boys and young men in their formative years helps to shape their view of women as equals. This approach at the community level must be reinforced by policies that establish this equality as a social norm. By educating men about the consequences of their actions, and enforcing policies that favor equality, traditional ways of thinking can be challenged and changed.

The 16 Days Campaign to End Violence Against Women: From 25 November to 10 December, USAID will post a blog each day that aims to prove a single point: The human race cannot progress when half of the world population lives without the same rights and respect afforded to its male counterpart. If you are moved by what you read and want to share, we’ve made it easy for you. Click here to find out how.

Recognizing Community Health Workers in Afghanistan

This originally appeared on Dipnote.

In support of the United Nations designated International Volunteer Day for Economic and Social Development, Afghanistan‘s Ministry of Public Health celebrated its annual Community Health Worker Day on December 5, 2010. Acting Minister of Public Health Dr. Suraya Dalil, USAID Senior Deputy Mission Director Robert Hellyer, other government officials, and international donors joined in recognizing the critical contribution of community health workers in Afghanistan and encouraging them to continue their voluntary support to their communities.

USAID Senior Deputy Director Robert Hellyer commends one of 22,000 community health workers in the annual celebration of Community Health Worker Day. Photo credit: USAID/ Afghanistan, Robert Sauers

The event praised the contributions of the more than 22,000 volunteers throughout the country who deliver community level health-education, counseling, and services out of village health posts located in private homes. The Ministry of Public Health envisioned that community-based healthcare programs will actively encourage communities and families to adopt healthy lifestyles and behaviors, and provide families access to high quality and socially acceptable preventative medicine and life-saving services.

“We have 22,000 community health workers in Afghanistan that are able to implement the basic and standard medicines. They all have been trained through a job description,” said Minister Dalil. Addressing the health workers, she added, “I am proud…that I have people like you.”

USAID-funded health projects collaborate closely with the Ministry of Public Health to improve the health and nutritional status of Afghans, provide quality primary healthcare, and promote healthy behaviors at the community and household-levels. USAID supported the training of more than 9,000 of the volunteer community health workers currently working in Afghanistan.

“On behalf of the American people, I congratulate the community health workers for their diligence to gain the skills and knowledge necessary to serve their communities in this important role,” said USAID Senior Deputy Mission Director Hellyer. “USAID strongly supports community based health care and believes that quality community-based health services are essential to reaching Afghanistan’s Millennium Development Goals.”

USAID assisted in developing the community health worker training manual, helped train community health worker supervisors and master-trainers, facilitated in-service training, and produced and developed reporting tools, job aids, and education materials.

Taking a Stand Against Violence Now

“Girls have been made to believe that they need someone to survive.”

These powerful words came from one of the commentators in the short documentary, SASA!, a film about women, violence and HIV/AIDS.

Sasa is Kiswahili for “now.” As in now is the time to take a stand against women’s violence. And we need to make this change now.

SASA! tells the powerful story of Josephine and Mama Joyce, two women from different countries, but in similar situations. Beaten, abused, pushed down, and left HIV positive by the men they married.

As young women, they were made to feel powerless and told they wouldn’t be happy unless they were with a man—even a man who abuses them.

Their situations are not isolated cases; globally, at least one out of every four women is beaten, coerced into sex, or otherwise abused during her lifetime.

One out of four.

Gender based violence (GBV), is a pervasive public health and human rights issue throughout the world. GBV consists of sexual, physical, emotional and/or financial abuse and is manifested throughout the life cycle.

Furthermore, this type of violence against another human being has negative health consequences.

In Mama Joyce and Josephine’s situations, they were both left HIV positive. Josephine’s husband slept with other women, and when she brought up the use of a condom, he beat her. And even though she protested, he forced sex on her. Adding salt to the wound, her in-laws blamed their son’s death on her. Mama Joyce’s husband left her and his second wife, leaving Mama Joyce to take care of her ailing “co-wife.”

But these women remained strong. They became leaders in their communities, hold support groups, and encourage other women who are in similar situations.End Violence Against Women Graphic

USAID, through the Global Health Initiative, is fully committed to preventing and responding to gender-based violence. Interventions work with both men and women to address the multiple factors at various levels that fuel the issue, and we are looking to help make a change in these women’s lives now.

Listening to Patients: How one Facility Made it easier for Patients on ART to Remain in Care

During a site visit with the USAID Health Care Improvement (HCI) Project in Uganda the Quality Improvement team at the Bwera Hospital in the Kasese District showed me data they collected on patients retained from August 2009 to November 2009. They found that only 54 percent of the patients ever started on treatment were still in care. The team leader told me “This is surprising; I thought everybody was here because the clinic is always busy.”

We then discussed ways to improve the situation, and it was decided the health care workers will begin asking patients why they had missed their visits and, more importantly, what they wanted from the clinic so that they wouldn’t miss visits in the future.

My work with the HCI Project supports the Uganda Ministry of Health to implement the Quality of Care Initiative, which aims to improve the quality of HIV services. Over the past ten months, I worked with 14 facilities to ensure that everyone who receives antiretroviral (ARV) medicine remains in care. This entails visiting facilities, such as the one in Kasese, to help them form quality improvement teams, identify areas for improvement, plan improvement projects and measure their performance.

When I returned two months after my initial visit to Bwera Hospital, the team told me that the most common reason for missed appointments was because monthly appointments were hard to keep due to transport problems.  The patients asked for two months worth of ARVs to be dispensed so they could come less often.  The staff listened to their clients and began distributing  a two month supply of ARVs.  They were proud to show me that more patients were now keeping their appointments.

Said one patient:

“Traveling to the hospital for drugs every month was very difficult.  I would lose 2 days of business every month to travel which also affected my health. When I discussed my problem and suggestions with the health workers, they accepted to give me treatment of more than one month. Now I have an obligation to remain adherent to treatment and keep my appointments to continue enjoying this.  My business is not affected anymore and I am able to save money to cater for other things.”

From this experience, I learned that listening to the perspective of patients in health care gives them a sense of relief and satisfaction with care. Health care workers also find the management of patients more fulfilling when the clients are directly involved. Thanks to the American People for making this happen.

Mabel is a Quality Improvement Advisor working with USAID’s Health Care Improvement Project (HCI). HCI is a five-year task order contract issued by USAID to support countries in improving the quality and impact of health services.

Helping Women Avoid HIV Infection and Transmission

HIV-positive and pregnant with her second child, Grace Abalo was like many other women in the developing world- in need of services to prevent her child from contracting HIV. Determined to have her baby born healthy, Grace and her husband joined a USAID-funded family support group at the health center near their home in Uganda.

There Grace learned how to access prevention of mother-to-child transmission (PMTCT) programs and other services that support their health in the long term, as well as strategies for positive living, safe infant feeding, and healthy child care.

“I learned why and how to adhere to cotrimoxazole prophylaxis, what antiretroviral therapy is, and which breastfeeding options would not put my children at risk of being infected,” said Grace.

Armed with knowledge and support, Grace was able to ensure her child stayed HIV negative. She and her husband continued to receive ongoing support through the network of people living with HIV/AIDS, and she has even begun to help other HIV-positive mothers take their children for testing and educates them on breastfeeding options.

With women of childbearing age accounting for more than half of the people living with HIV/AIDS, PMTCT programs are vital to end the HIV/AIDS epidemic. And while these interventions are aimed at women, it is just as important to gain support and participation from their male partners. Like Grace, the support of the men in the life of an HIV-positive woman can make a tremendous difference. With education of men, comes the understanding of the disease, how it’s spread, and how to treat it. This then can result in positive changes in gender, social and cultural norms.

Across the world women just like Grace deserve a chance to have healthy babies. Through the Global Health Initiative, USAID will continue to work to provide every woman with the opportunity to have a healthy child.

50 Weeks to 50 Years at USAID – Week 3: Fighting HIV/AIDS

I had just finished my first year of graduate school at UCLA when the first case of HIV was reported in Los Angeles. Little did I know how that event, happening so close to my school, would affect and influence my professional life. Over the next three decades, HIV/AIDS would play a central role in my USAID career and become a passion and driver of my work.

As deputy director of the Health and Nutrition Office in the 1990s, I helped oversee the HIV/AIDS division’s work and program. But HIV/AIDS was only a disease I read about and discussed. It took my Foreign Service posting in Zambia in 1998 for HIV/AIDS to become real.

One in five Zambians was HIV positive, and because the epidemic had been underway for 15 years, illness and death were at an all time peak. Our home was on the road to the city cemetery, and long funeral processions were daily occurrences.

It was during my first year there that I personally experienced the devastating death of one of my staff from AIDS. It changed our entire office and we were inspired to do all we could to ensure others did not face the same fate. It was those five years in Zambia, at the heart of the HIV/AIDS epidemic, which convinced me of the importance of prevention—especially reaching the next generation with effective messages.

Reading the predictions for the next HIV/AIDS wave to hit key Asian countries, I was motivated to share what I learned in southern Africa with this region.

With my five-year assignment to India, I was witness to the large scale expansion of the Indian response to high risk groups and key geographic areas. We focused the majority of our efforts on building the local capacity of the government and civil society to ensure sustainability.

The scale of this effort was enormous given that most Indian states’ populations are greater than those of many countries.

I am now back in Washington, leading the HIV/AIDS Office in the Bureau for Global Health. This is a very important time as the second phase of the President’s Emergency Plan for AIDS Relief (PEPFAR) is being implemented with a greater focus on sustainability and country ownership. And with President Obama’s Global Health Initiative underway, USAID is working with our U.S. Government partner agencies to improve integration among our programs.

We have made tremendous progress over these some 30 years—PEPFAR is currently supporting over 3.2 million people on lifesaving antiretroviral (ARV) drugs, and with USG support in fiscal year 2010 alone more than 114,000 infants were born HIV-free.  Through partnerships with more than 30 countries, PEPFAR  directly supported 11 million people with care and support and provided nearly 33 million people with HIV counseling a testing.

It has also been an exciting time for prevention with the results of the USAID-funded CAPRISA trial proving a microbicide could help prevent HIV transmission. This was met with enthusiasm by the HIV/AIDS community, and Administrator Shah is supportive of an aggressive way forward to advance microbicides from proof of concept to impact in the field to slow transmission of HIV.

So on this World AIDS Day and in the coming year, we should all honor the 33.3 million people who are currently living with HIV and the millions more who have died from this epidemic, and recommit ourselves to do all we can to address the personal tragedy caused by HIV/AIDS.

A Brief History of USAID’s Role in HIV/AIDS

•         1986: USAID officially begins HIV/AIDS programs in the developing world. This is only two years after HIV, the virus that causes AIDS, was isolated and identified.

•         1988: USAID’s Demographic and Health Survey begins collecting data on HIV.

•         1993: USAID is a founding member of the International HIV/AIDS Alliance

•         1998: USAID launches the IMPACT program for HIV prevention and care.

•         2000: USAID launched Regional HIV/AIDS Program for Southern Africa.

•         2001: USAID officially launches the Office of HIV/AIDS within the Bureau for Global Health.

•         2001: USAID begins partnership with the International AIDS Vaccine Initiative.

•         1998: USAID launches the IMPACT program for HIV prevention and care.

•         2000: USAID launched Regional HIV/AIDS Program for Southern Africa.

•         2001: USAID officially launches the Office of HIV/AIDS within the Bureau for Global Health.

•         2001: USAID begins partnership with the International AIDS Vaccine Initiative.

•         2003: The U.S. President’s Emergency Plan for AIDS Relief is announced

•         2005: PEPFAR, in conjunction with USAID, launched the Supply Chain Management System Project

•         2008: The $48 billion Lantos-Hyde reauthorization bill on HIV/AIDS, TB, and malaria is signed into law

•         2009: The President’s Global Health Initiative is announced

•         2010: the CAPRISA 004 trial provides the first ever proof of concept that a microbicide can prevent HIV transmission

HIV Prevalence Triples in Eastern Europe and Central Asia Over Past Decade

I believe tough news has to be faced squarely and challenges need to be met head on. It is alarming that the recent UNAIDS Report on the Global AIDS Epidemic found that the number of people living with HIV in Eastern Europe and Central Asia has nearly tripled since 2000 reaching an estimated total of 1.4 million people in 2009. This report should be a renewed call to action.

In contrast to the encouraging reports from other regions of the world, Eastern Europe and Central Asia have experienced the largest regional increase in HIV prevalence, with the Russian Federation and Ukraine accounting for nearly 90 percent of the newly reported infections in the region. The report also found a more than four-fold increase in the number of AIDS-related deaths from 2001 to 2009 in the region. In comparison, globally there has been a 20% decrease in new HIV infections over the past decade, and fewer AIDS-related deaths over the past few years due to anti-retroviral therapy.

HIV testing at Ukrainian clinic Photo Credit: USAID/Ukraine

The epidemic in Eastern Europe and Central Asia is concentrated among marginalized groups such as people who inject drugs, sex workers, their sexual partners, and men who have sex with men (MSM). There are many reasons that HIV infections continue to grow in Europe and Eurasia, from drug addiction to social or cultural stigma about sexual orientation. None of these should be insurmountable obstacles to working to prevent HIV infections.

USAID and the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR) directly support HIV/AIDS prevention programs in Russia, Ukraine, and Georgia. In Russia, activities focus on providing technical assistance to local counterparts to design and implement effective prevention and care programs for those most at risk of HIV infection. In Ukraine, through the Sunrise Project, USAID funds a pilot program of methadone-based Medication Assisted Treatment to provide 300 HIV-infected male and female injecting drug users with access to a package of services that includes MAT and related medical, legal, social and psychological care. The SHIP Project in Georgia supported HIV prevention among high risk groups; through this intervention, the use of shared injecting drug equipment was reported to decrease from 79% in 2002 to below 43% in 2005.

Regionally, USAID and PEPFAR work to address the concentrated epidemic through a variety of activities, including the development of the Medication Assisted Therapy (MAT) Policy Toolkit. The toolkit will help to prevent HIV by providing information for advocates and policy makers working to support MAT implementation for injection drug users. Another regional activity supported a situational assessment of MSM and HIV in the region that reviewed data, information, and programs for MSM and identified gaps and potential activities to address some of these gaps.

As we celebrate the success of global efforts to prevent the spread of HIV and AIDS, we cannot forget about the most-at-risk populations in the Eastern Europe and Central Asia region. While USAID, PEPFAR, and the governments and NGOs in the region have HIV/AIDS prevention and treatment programs in place, we all still have much work to do in order to control the epidemic. We need to face the tough news and work together even harder to save more lives.

Fighting HIV With Circumcision

This originally appeared on Zeke Emanuel’s Africa Diaries. This is Part Six.

Dr. Emanuel, from the White House Office of Management and Budget, blogged extensively during a recent two-week trip through Africa.  In this installment he discusses the potential for using male circumcision to prevent HIV transmission.

Three separate randomized trials have shown that male circumcision is among the most effective interventions against HIV/AIDS, reducing transmission by about 60 percent. This is a huge impact. As one AIDS researcher has said to me, if we had a vaccine that effective, we would be sparing no effort to distribute and administer it.  But widespread deployment of male circumcision has not yet occurred.

He goes on to address issues of manpower, facilities, cost, and cultural barriers. Learn more and read the complete post at The New Republic.

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