USAID Impact Photo Credit: USAID and Partners

Archives for Global Health

Let’s Talk About HIV: The Importance of Dialogue and Information in Adolescent HIV Care

In recognition of International Youth Day, AIDSTAR-One Senior Treatment Officer discusses the importance of dialogue and information in adolescent HIV care. 

Imagine you are 15. It is your first year at a new school. You have to make new friends, meet all new teachers, struggle through your classes, and find a date for weekend parties. You want freedom and independence from your parents and caregivers. You want to be like everyone else. You worry about having cool clothes and fitting in.  You want to have a boyfriend or girlfriend. You want your friends to like you. You worry about getting in to university and what your future will be like.

Now, imagine you are 15 and you are HIV-positive. You have the same thoughts and concerns that your peers have, but you also have to worry about your health. HIV only makes being an adolescent harder. You wonder if you will still fit in if you have HIV, so you hide this information from your friends. When you start dating someone, you wonder if your boyfriend or girlfriend will still like you if you tell him or her your status. The pressure of getting good grades and planning a successful future is heightened by having to miss school for medical appointments or not feeling well.

Teen Talk, a new tool from AIDSTAR-One and BIPAI, is a resource for young adults living with HIV. Photo credit: AIDSTAR-One

Teen Talk, a new tool from AIDSTAR-One and BIPAI, is a resource for young adults living with HIV. Photo credit: AIDSTAR-One

Through advances in antiretroviral therapy (ART), children born with HIV are growing up, living, and thriving. In addition, UNAIDS reports that youth between the ages of 15-24 account for almost half of all new HIV infections. These youth are in need of comprehensive, youth-specific education to empower them to make responsible and informed decisions regarding disclosure of their HIV status, sexual behavior, and their health.

So, how do we help youth living with HIV adjust to the growing pains of adolescence, while also maintaining their health? We talk to them. Just as with any teenager, it is important for youth living with HIV to learn how to be responsible young adults, realize how their actions affect those around them, and know who they can talk to when they need help. For teenagers who are HIV-positive, it is also important to help them manage their health. They need to know how to remain healthy by eating well and remembering to take their medicine, how and when to talk to peers and teachers about their status, and why drinking or taking drugs could be particularly harmful to them.

It is hard for youth living with HIV and those who care for them to know the answers to all of these questions. AIDSTAR-One in partnership with Baylor International Pediatric AIDS Initiative (BIPAI) created Teen Talk: A Guide for Positive Living, a resource written for teens to use on their own, or for use in consultation with medical providers or caregivers. Covering issues such as adherence, nutrition, and safe sex, Teen Talk helps youth living with HIV think through their concerns and make healthy decisions. Teen Talk offers specific tools such as a calendar to help adolescents remember to take their medicine, a list of common medication side effects and possible solutions, and a question and answer guide about sex and sexual health.

With such a large population of youth living with HIV, it is increasingly important to help adolescents address their HIV status, manage their own medical care, and live a healthy life.  Living with HIV will always be a challenge. However, with tools such as Teen Talk, youth living with HIV can thrive and remain healthy in their adolescent years, bringing us one step closer to reaching the global goal of an AIDS-free generation.

AIDSTAR-One is funded by PEPFAR through USAID’s Office of HIV/AIDS. The project provides technical assistance to USAID and U.S. Government country teams to build effective, well-managed, and sustainable HIV and AIDS programs.

Learn more about youth programming at USAID. Join the conversation on Twitter using #IYD2013. 

Youth, Urbanization and Health

In celebration of International Youth Day, Global Health Youth Advisor discusses U.S. Government and USAID’s health programs impacting urban youth. 

In 2010 I took a bike tour of Dar es Salaam’s slums. Over tea and chapattis my young guide told me he had lost both parents to AIDS. As the eldest, he had to ensure the education of his younger siblings. He dropped out of high school and migrated to Dar to work. Now at 24 with a good job, his siblings had finished school, and he was ready to return to school himself.

This glimpse of the vibrant yet chaotic life in Dar’s slums is one that we rarely see. I was struck by the large numbers of school-age youth in the streets working as petty traders: selling bananas, phone cards, sunglasses and pirated DVDs.

The HealthyActions program in Liberia, under the Advancing Youth Project and in partnership with EDC delivers an HIV and family planning curriculum in alternative high schools for youth that have left the formal education system. Photo credit: USAID

The HealthyActions program in Liberia, under the Advancing Youth Project and in partnership with EDC delivers an HIV and family planning curriculum in alternative high schools for youth that have left the formal education system. Photo credit: USAID

Dar is not unique. Rural to urban migration is accelerating, yet governments are ill-prepared to deal with it. In Timor L’este, I heard that that the capital’s population was growing by 10,000 people every year. Poorly serviced squatter settlements, slums, and camps are the norm in many cities, which are increasingly populated by youth seeking opportunities.

In Latin America and Asia, young female urban migrants outnumber young males. Many migrate to escape forced marriage or abusive relationships. UNICEF data from 12 countries show one in five migrant children aged 12–14 and half of those aged 15–17 move without a parent. Young urban migrants often find themselves in violent, stressful and unhealthy environments.

Migration displaces and separate youth from their homes and the protective structure and guidance of families and communities. Separation from sources of learning, recreation, and support; alteration of community routine, normalcy; and lack of positive alternatives contribute to the exploitation and abuse of young people. Young people also engage in risky behaviors, including sexual ones with dire consequences.

Developmentally appropriate reproductive health and family planning information and youth friendly services can prevent poor health outcomes, and can ensure young people receive adequate care and  support for pregnancy, unsafe abortion, STIs/HIV, and violence.

Youth face many challenges to obtaining reproductive health services. Youth migrants are doubly challenged, since slums have limited health services. Urban programs must address and involve youth. Collaboration across sectors is essential to improving the health and opportunities of urban youth migrants.

U.S. Government and USAID’s health programs impacting urban youth:

  • Young Tanzanian women who migrate to the city are susceptible to the lure of a “sugar daddy.” The Fataki radio campaign (PDF) uses humor and familiar stories to foster dialogue around the dangers of intergenerational sex, empowering community members to intervene.

  • Fourteen years of civil war in Liberia displaced much of the population. Population Services International provides HIV and FP education in alternative high schools for youth now returning to Monrovia, with increased uptake of HIV testing and contraceptives.

  • One third of the 6 billion mobile subscribers are under the age of 30. Mobile for Reproductive Health (m4RH) is an on-demand SMS system with information about contraception and nearby clinics. Young Kenyans liked the simple language and confidentiality of the service. Tanzanian and Kenyan users reported increased contraceptive knowledge and use. FHI 360 and the Rwandan Ministry of Health are adapting m4RH with additional information for young people.

Globally, young people under 18 are considered children, and younger migrants are at especially high risk. The U.S. Government’s Action Plan for Children in Adversity recommends that U.S. Government assistance support and enable families to care for their children; prevent unnecessary family-child separation; and promote appropriate, protective, and permanent family care.

Learn more about youth programming at USAID. Join the conversation on Twitter using #IYD2013. 

HIV+ and Pregnant: A Deadly Combination?

Since 1990, the global number of maternal deaths has declined by almost half to 287,000 per year. Increased access to family planning and improved maternity care, including emergency care when needed, have played a significant part in this reduction. At the same time, the number of people dying from AIDS-related deaths has been declining since the 2000s because of access to life-saving antiretroviral therapy (ARVs) and a decline in HIV prevalence. Nonetheless, these positive trends are masking a troubling reality for many women in Sub-Saharan Africa. According to new estimates, HIV-positive pregnant women had 8 times the risk of death during pregnancy than HIV-negative pregnant women.

A couple from Nigeria holds their 5-month-old HIV-negative baby. Photo credit: Deidre Schoo, International Center for AIDS Care and Treatment Programs, Columbia University School of Public Health

A couple from Nigeria holds their 5-month-old HIV-negative baby. Photo credit: Deidre Schoo, International Center for AIDS Care and Treatment Programs, Columbia University School of Public Health

It’s a sobering statistic, and it calls both the HIV and maternal health communities to joint action. But what can be done? How can we improve HIV and maternal health programs to save the lives of these women? Unfortunately, the answer is unsatisfying. We just don’t know the solution…yet. Certainly the provision of ARVs to HIV-positive pregnant women for her health and the health of her child is a vital piece of the puzzle. Many countries are shifting their strategies to reach these women by providing lifelong treatment for pregnant women living with HIV. However, ARVs are probably not the entire answer as HIV-positive pregnant women also have an increased risk for complications relating to other co-infections like tuberculosis, sepsis, and pneumonia. Questions remain, and more research on the nexus of HIV and pregnancy is necessary.

In an effort to move the HIV and maternal health communities to action, USAID, CDC, and the Maternal Health Task Force convened a meeting in early June on “Maternal Health, HIV and AIDS: Examining Research through a Programmatic Lens.” We brought together technical experts from around the world who have been investigating the intersection of HIV and maternal health. We were electrified by the dynamic group and the data presented on topics ranging from causes of maternal deaths, stigma and discrimination in health services, and tough considerations around Option B+. A smaller group committed to develop a formal research agenda to outline the priority questions that remain.

This meeting was just the beginning of the dialogue, and we’d like to invite you to participate in the conversation and add to the evidence base as we move forward. The full content of the meeting is available online at the Maternal Health Task Force’s website. We continue to seek the latest resources, research findings, and publications from around the world on this topic. To read more on the subject, find relevant news and publications, and suggest additional resources, see here. Finally, watch for more news from USAID as we continue these important discussions and learn more from sub-Saharan African countries that are tackling this issue.

Coordinated Efforts Needed to Combat Infant Mortality in Africa

At the Africa regional conference of the International Confederation of Midwives (ICM) held last month in Nairobi, Kenya, one thing was clear. In order to meet the United Nations Millennium Development Goal (MDGs) of reducing infant mortality by two thirds before 2015, birth attendants in large numbers must acquire the basic skills and equipment to help newborns breathe.

The WHO estimates that one million babies die each year from birth asphyxia, the inability to breathe immediately after delivery. Simple means to stimulate breathing that could easily be done by a birth attendant could save a majority of these babies. However, such lifesaving care is not available in much of the world’s poorest regions.

Attendees at the session get a primer on the HBB program. Photo credit: Johnson & Johnson

Attendees at the session get a primer on the HBB program. Photo credit: Johnson & Johnson

As part of its MDG commitment, Johnson & Johnson is working with USAID and many partners globally to address birth asphyxia through its support of the Helping Babies Breathe (HBB) program in a number of developing countries where infant mortality from birth asphyxia is still high. HBB is a global public-private partnership working towards achieving a significant reduction in newborn mortality by increasing the availability of skilled birth attendants at every birth. Nurses and midwives with HBB training have the skills to save over 90% of babies with birth asphyxia.

The ICM meeting dedicated a core session to HBB, including providing attendees hands-on HBB introductory training and a related symposium that debated why little progress has been made in combating infant mortality in Africa.

The discussion continued at the stakeholder consultation meeting the morning after the conference ended, with a more specific focus on Kenya, where five babies die every hour. These discussions were attended by representatives from the HBB global alliance, including USAID, AAP, AMREF and Johnson & Johnson. Dr. Santau Migiro, head of reproductive health in Kenya’s Ministry of Health (MOH), was also in attendance.

What became increasingly evident was that to accelerate progress, all HBB activities need to be implemented in coordination. Rather than small scale activities done in isolation, the key to making a high impact is to address the issue on a much larger scale. Collaboration and synergy among players is important to maximize efforts, funding and resources, and to advocate for policy change.

To that end, all stakeholders agreed that the best way to push HBB forward in Kenya is to work under the MOH umbrella, making it part of the overall MOH maternal and child health strategy. Already, the Kenyan MOH has made HBB competency part of the core curriculum of medical training, recognizing that all health workers have a role in impacting maternal and neonatal health.

In addition to making the most effective use of resources and funding, a harmonized approach lends itself to better monitoring and evaluation. Standard guidelines for implementation will provide more meaningful data about the results of the program.

While the immediate focus of the stakeholders meeting was implementing HBB effectively in Kenya, there was general consensus that this direction is the right way to move the HBB initiative forward across the continent.

The evidence that HBB can be effective in Africa is there already. Tanzania, where over 3000 health care workers have been trained, has seen a drop of over 47% in infant mortality.

The conference was an opportunity to get all players in the region, including over 400 midwives from 20 African countries, on the same page. While recognizing that a lot more needs to be done, attendees left with a feeling of optimism, celebration and camaraderie overall.

Rene Kiamba manages the Johnson & Johnson Family of Companies corporate contributions community support programs and initiatives in sub-Saharan Africa.

From the Field in Zimbabwe: Unexpectedly HIV-Free

For a pregnant woman, it takes courage to visit Epworth Clinic in Harare, Zimbabwe. Many must travel long distances to get there, but that is not the only reason. They come to the clinic to learn their HIV status or to receive antiretroviral (ARV) medication, and when they first arrive, many of the women have little hope of giving birth to a healthy child. Once they get there, however, they learn that although they have HIV, they do not need to pass it to their children.

I visited the clinic to learn how USAID is supporting the delivery of high-quality HIV/AIDS services in Zimbabwe.

Rosemary proudly holds her HIV-free baby after receiving prenatal treatment from a USAID-sponsored clinic outside Harare, Zimbabwe. Photo credit: Zoe Halpert, USAID intern

In the waiting room, I spoke with Rosemary, a 40-year-old, HIV-positive mother who was holding an 8-month-old baby. Rosemary came to the clinic for the first time several years ago when her husband’s health began to deteriorate and she suspected that they might both be HIV-positive. She was right; she tested positive for HIV and began ARV treatment several weeks later. While I was talking with Rosemary, her baby sleepily opened her eyes and chewed her blanket. She was born healthy and HIV-free.

The prevention of mother-to-child transmission of HIV-AIDS program at Epworth clinic started in 2001. USAID provides infant HIV test kits and ARVs to many clinics throughout Zimbabwe, including Epworth. USAID’s partner, the Organisation for Public Health Interventions and Development (OPHID), provides training and supervision to the health-care workers in the clinic.  With support from USAID, this local organization is quickly increasing its ability to better address the HIV-AIDS epidemic in Zimbabwe.

Epworth clinic sees about 80 pregnant women and nursing mothers each day. When they first arrive at the clinic, they are tested for HIV and educated about family planning. As a result of the support the clinic has received from USAID, through OPHID, the number of HIV-positive babies has gone down significantly. Today, 98 percent of babies that are part of the program test negative.

When I talked with the clinic’s nurses, they told me, “If we didn’t have the USAID program, 98 percent of our patient’s babies would be HIV positive.” They also acknowledged that there would be a significant population decline.

As my visit came to a close, I asked Rosemary what advice she would give to other pregnant women. “Every woman should know her HIV status,” she said. She has found the courage to tell some of her friends her status, and strongly encourages them to get tested for their entire family’s benefit.

Visit OPHID for more information about OPHID.

Learn more about USAID’s work in Zimbabwe

From the Field in South Sudan: Mother of Nine Helps Rural Women Deliver Safely

At age 38, Mary Konyo has nine children, including a set of twins. She has been a traditional birth attendant since 1997, before South Sudan became independent, and has helped 23 women deliver children safely women in the last 16 years. Two years ago, she decided to stop having children so she could focus more on helping other pregnant women in distress.

I was touched by Konyo’s story when I heard it at a public forum in Juba (South Sudan’s capital), and I contacted her to learn more about her work to save the lives of pregnant women in her community.

Mary Konyo (right) testifies on the benefits of using misoprostol to reduce severe bleeding after childbirth.  Photo: Victor Lugala

Mary Konyo (right) testifies on the benefits of using misoprostol to reduce severe bleeding after childbirth. Photo credit: Victor Lugala

Her personal experiences with childbirth have inspired her. “When I delivered my first child, I bled excessively for three days. I was very weak,” Konyo told me.

A majority of rural South Sudanese women deliver at home, mostly without the help of a midwife, and some of them die from complications. Excessive bleeding after childbirth, or postpartum hemorrhage (PPH), is one of the leading causes of maternal death in South Sudan.

In recognition of her community work, Konyo was among a few women nominated from her community to attend a USAID-funded workshop on reducing PPH. Workshop participants gained knowledge and skills to help them talk with their communities about the importance of using misoprostol — a medicine that can prevent severe bleeding — to prevent PPH. They also learned what to do when a woman experiences PPH.

In addition to practical skills, the workshop emphasized the need for community outreach to help people understand the importance of giving birth in a health facility, where it can be easier to address complications. Konyo returned to her community as a home health promoter and started a door-to-door awareness campaign. She advises pregnant women to regularly attend antenatal clinic to help ensure that they have safe deliveries. “I particularly tell them about the dangers of excessive bleeding after birth,” Konyo said.

She is also able to give pregnant women misoprostol to take immediately after giving birth. But, she added, “I always tell women to deliver safely in the clinic.” Aware of rural poverty, Konyo advises pregnant women to save a little money for their transport to the hospital for delivery. In her community, women in labor are often transported to the nearest clinic on motorbike taxis, called boda-bodas.

Konyo told me she also encourages husbands to accompany their wives to the clinic, adding that men are expected to pay the hospital bills when their wives give birth.

She believes misoprostol will help drastically reduce severe bleeding immediately after childbirth in her community, pointing out that women who take misoprostol regain strength on the third day after delivery and can return to their everyday activities more quickly. Konyo says the men whose wives have used misoprostol are also happy: “Now they are asking for a ‘wonder medicine’ that will reduce birth pangs and hasten childbirth.”

Learn more about USAID’s work in South Sudan and follow USAID South Sudan on Facebook and Twitter (@USAIDSouthSudan)!

River Blindness Eliminated in Colombia

Today, Colombia celebrates a great milestone. According to the World Health Organization (WHO), out of 38 endemic countries worldwide, Colombia is the first to eliminate river blindness, a disease transmitted through infected flies that can cause chronic skin lesions, irreversible blindness, or severe visual impairment.

In Naciona, Colombia, a child is measured for treatment with the drug Mecitzan®, donated by Merck. The village of Naciona's close proximity to the river meant that, in the past, residents were exposed to the bites of flies that carried river blindness. Now, thanks to the work of the national program and the Carter Center OEPA Colombia has eliminated river blindness nationwide. Photo Credit: Carter Center

Approximately 123 million people are at risk of infection of river blindness and at least 25.7 million people are currently infected of which 1 million suffer from blindness or visual impairment. River blindness is traditionally controlled via mass drug administration given to affected communities. Fortunately, since 1987, the drug needed to control this disease has been donated free of charge by Merck.

In Colombia, river blindness affected a single community in the municipality of Lopez de Micay in the Cauca State. A remote location reachable only by a 10-hour trip in a small motorboat. In 1996, Colombia began an intensive public health campaign to break the transmission cycle by administering treatment for river blindness to this entire community. These efforts were sustained until 2007 when it was determined that the cycle of transmission had been broken. Mass drug administration was halted in 2008.

In order to receive certification of elimination, Colombia had to undergo a 3-year post-treatment surveillance period where data is collected and analyzed to determine if river blindness is still present in the community. In addition, Colombia had to submit a country dossier to WHO describing the entire history and achievements of their country program.

After a visit by a team of international experts and an extensive review, WHO verified the elimination of river blindness in Colombia and was announced earlier today by Colombia’s President Juan Manuel Santos.

This milestone could not have been achieved without the work of many organizations. Merck’s drug donation program has been key in the success of controlling and beginning to eliminate river blindness from the world. The leadership and technical assistance from the Pan American Health Organization (PAHO) and the Carter Center’s Onchocerciasis Elimination Program for the Americas (OEPA) to the six affected countries in the Americas has been essential to reach this milestone.

For USAID, river blindness elimination from the Americas was a specific target set when the Global Health Initiative was launched in 2009. Since then, USAID has worked in close coordination with the Centers of Disease Control and Prevention, and currently funds PAHO and OEPA’s work.

In the Americas, Ecuador is expected to be the next country to receive verification of elimination and Guatemala and Mexico are soon to follow. In the western hemisphere, only one remote area at the border between Brazil and Venezuela continues to be affected by river blindness.

The efforts and success seen in Colombia serve as a model for countries globally and paves a way toward a world free of river blindness.

Demographic and Health Survey Show Positive Results in Haiti

A newly released nationwide health survey of Haiti shows continuing positive trends on key health-care indicators in particular those of Haitian women and children. The latest survey, undertaken by the Haitian Ministry of Public Health and Population, was conducted in 2012 and compares with the prior survey done in 2006. It shows steady improvements among key indicators despite significant health challenges in Haiti due to the 2010 earthquake and cholera outbreak. Of note were improved indicators for child vaccination and malnutrition, infant and child mortality, women’s health and contraception use. The report indicated no increase in HIV prevalence, which remained steady.

Patients get laboratory work done at a USAID-supported health clinic in Ouanaminthe, Haiti on May 15, 2013. Photo credit: Kendra Helmer/USAID

The Morbidity, Mortality, and Service Utilization Survey measures progress and setbacks in health outcomes over the years. The results were announced July 9 by Dr. Florence Guillaume Duperval, Haiti’s Minister of Public Health and Population. The survey has been administered in Haiti five times since 1994.

The previous survey was administered in Haiti between 2005 and 2006; this latest survey was conducted from January 2012 to June 2012. Over 13,000 households participated in the current survey, representing rural and urban areas in all of Haiti’s 10 departments, including camps for people displaced by the January 2010 earthquake. The results were eagerly anticipated by health experts concerned of possible setbacks brought on by the devastating quake, which killed more than 230,000 people and displaced more than 1.5 million.

However, the survey results show that many health outcomes have improved in Haiti. The data collected in the survey show improvements in women’s health, improved nutritional status among the population, and an increase in use of contraceptive methods. Currently, more than two-thirds of pregnant Haitians have made the recommended number of antenatal visits, an increase from 50 percent in 2006; the prevalence of anemia among women has declined from 55 percent in 2000 to 49 percent in 2012; and the use of modern contraceptive methods among married women has increased from 22 percent to 31 percent between 2000 and 2012.

Health data for children also showed positive results. Childhood vaccinations increased from 53 percent in 2006 to 62.5 percent in 2012. With regard to nutrition, the survey showed that 22 percent of children under 5 suffer from chronic malnutrition, a decrease from 29 percent in 2006. The survey also revealed a decrease in acute malnutrition from 10 percent in 2006 to 5 percent in 2012 and a decrease in percent of children underweight from 18 percent to 11 percent.

Childhood mortality has decreased in Haiti over the last 15 years. Survey results show that infant mortality has decreased from 79 to 59 deaths for 1,000 live births. In addition, mortality for children under 5 has also decreased from 112 deaths to 88 deaths per 1,000 live births.

Among other results, the survey revealed that the HIV prevalence among those ages 15-59 have remained the same:  2.7 percent among women and 1.7 percent among men.

USAID is working closely with the Government of Haiti to continue to improve health outcomes for all Haitians. “The information in this survey forces us to continue to work together, to strengthen our interventions and our methods so that progress in the health sector in Haiti is sustained,” said Marc Desjardins, Deputy Chief of Mission of the U.S. Embassy in Port-au-Prince, during the July 9 event.

USAID’s goal is to improve access to health care services and build the Government of Haiti’s capacity to manage and oversee its health programs. Currently, about 50 percent of the population has access to a vast network of USAID-sponsored health facilities throughout the country that provide core health services such as maternal and child health, family planning, and nutrition. In addition, diagnostic and treatment services for tuberculosis and HIV and AIDS services can be accessed at these health facilities. HIV and AIDS services include access to antiretroviral therapy, prevention of mother-to-child transmission, palliative care, and voluntary testing and counseling. USAID programs aim to reduce risky behaviors and maintaining people living with HIV and AIDS on treatment.

Much remains to be done in Haiti. For example, despite high levels of knowledge of family planning, only 35 percent of married women are using any method and 31 percent are using a modern method. However, the positive health trends revealed by this data shows that Haiti continues to move forward despite the earthquake, the ongoing cholera epidemic, and many other challenges that threaten health outcomes. These results are a testament to the hard work and strong commitment of all of those who work to build a better Haiti.

This survey was funded by USAID, the United Nations Children’s Fund (UNICEF), the United Nations Population Fund (UNFPA) and the Global Fund the Global Fund to fight AIDS, Tuberculosis, and Malaria through the United Nations Development Fund (UNDP), and the Canadian International Development Agency (CIDA).

The fifth Morbidity, Mortality, and Service Utilization Survey combined with the Multiple Cluster Indicator Survey (MICS) was conducted by the Haitian Childhood Institute [l’Institut Haïtien de l’Enfance (IHE)] in collaboration with the Haitian Statistical and Information Technology Institute [l’Institut Haïtien de Statistiques et d’Informatique (IHSI)]. This survey was supported by the Ministry of Public Health and Population [Ministère de la Santé Publique et de la Population (MSPP)], benefited from the technical assistance of the Demographic and Health Surveys program (MEASURE DHS), which is implemented by ICF International.

Resources:

  • Read the full DHS report.
  • See photos of USAID’s health-related programs in Haiti.

A Roadside Attraction in Djibouti: Community and Condoms at the SafeTStop

Whether on foot, camel, dhow, containership, tanker, or truck—traders have likely criss-crossed Djibouti and its waters for as long as there has been trade. Today, the Port of Djibouti, one of Africa’s busiest, lies at the nexus of major shipping routes between Asia, Africa, and Europe.

From Djibouti, most goods travel inland by trailer-truck: some 800 Ethiopian truckers arrive every day. After offloading coffee, cotton, beans and other commodities from Ethiopia, truckers wait 4 to 6 days to reload with imported electronics, spare parts, construction materials, food aid and much else.

This range of activity makes a small community, virtually unknown outside Djibouti, both important and vulnerable. It’s called PK-12 for “Point Kilometre 12″ in French, the official language. Meaning that it’s 12 km from Djibouti town, the capital and site of the port. PK-12 looks like the mother of all truckstops. Colorful vehicles lie like flattened dominoes as far as the eye can see—thousands of them.

Thanks to a public-private partnership between USAID, the Government of the Republic of Djibouti, FHI 360, and Dubai Ports World, the little container-hut at PK-12 will be replaced by a larger center.The new SafeTStop will feature testing and treatment on the premises, so clients will have a one-stop-shop for recreation plus HIV and other health services. Photo credit: Dubai Ports World

Understandably, drivers with several days on their hands also ferry back and forth another invisible item. About 25 percent are thought to be HIV-positive. The number of HIV-positive young women and men from the community is not known, and the stigma is too strong for even the boldest to disclose their status.

As late as 2004, HIV was a taboo subject, along with condoms. Voluntary testing did not exist. A lot of young women in this small roadside settlement were not only getting pregnant out of wedlock, they were also dying. If someone got a positive diagnosis—usually by showing up at a hospital with TB or another disease—they often took their own life.

“I got involved in HIV education because I used to lie awake at night worrying about my two daughters,” says Zahra Daher.  ”They were very young then, but what would happen later? There’s so little opportunity here except sex work.  It seemed like a death sentence.”

Zahra and I, along with three bearded imams and several peer counselors, are talking on the second floor of a little building made, fittingly, from one transport container atop another. This center for recreation and HIV education is a “SafeTStop”—one in a network of 52 in communities along the main highways of East Africa. The SafeTStops are part of the ROADS II program funded by the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR) through USAID and implemented by FHI 360.

Zahra Daher and Hussein Houmed, founders of the PK-12 SafeTStop. Photo credit: Carole Douglis, USAID/East Africa

A decade ago, before the SafeTStop existed, Daher and others here were chased, stoned, and accused of infecting people simply for talking about HIV. In 2004, Daher assembled a concerned women’s association. Hussein Houmed put together a youth association. Together, they sought support and funding. By 2005, they received both from PEPFAR through USAID/Djibouti.

The clerics—initially far from enthusiastic—were invited to join the initial training. They did, and today they preach prevention at community mosques. “Our target,” says Houmed, “was to inspire people to go for voluntary counseling and testing, so if they’re positive they start taking ARVs [antri-retroviral drugs] if needed. That way they can stay healthy and are also unlikely to pass the virus on.”

Peer counselors roam the local bars and restaurants, befriending people in Arabic, Afar, Somali, or Amharic, distributing condoms, and encouraging truckers and community members alike to be tested.

“The progress is very visible,” says Daher. “Before, no one mentioned the disease. Today we see people talking about it. We see people easily asking for condoms, going for testing, then going back for the results. People who are positive approaching us for advice. And undesired pregnancies are much rarer than they were.”

Thanks to a public-private partnership between USAID, the Government of the Republic of Djibouti, FHI 360, and Dubai Ports World, which operates the port of Djibouti, the little container-hut at PK-12 will be replaced by a larger center nearby. The new SafeTStop will feature testing and treatment on the premises, so clients will have a one-stop-shop for recreation, plus HIV and other health services.

“I’m taking this opportunity to thank American taxpayers and the Ambassador,” said Houmed after our interview. “Long life to the U.S. and the Government of Djibouti, who have made this partnership possible.”

FP2020: Plans, Partnerships and Progress – One Year On

This originally appeared on The Huffington Post Blog.

Sometimes it’s hard to tell if your work really makes a difference. Three months after the London Summit on Family Planning, I led a delegation of UNFPA supporters to Ghana. We saw a diverse and inspiring range of maternal health programs — from government hospitals to an entrepreneurial midwife who designed and produced birthing stools with the help of a local carpenter.

In Tamale, we visited a brand new Marie Stopes clinic fully stocked with a range of modern contraceptive methods. It was located in the heart of the city, at a vibrant, open air market that stands at the crossroads of three ancient trade routes. For the women and men who work there, the clinic could not be more convenient — they could easily dash off for an appointment or for supplies.

Ghana woman at USAID health event. Photo credit: USAID

From there we flew north to Bolgatanga, then traveled by bus towards the border with Burkina Faso. As we drove, the tarmac gave way to unpaved roads. Cracks became grooves, and grooves became ditches. As the hours passed, the villages became smaller and the distance between them grew. Wherever we were headed, it felt worlds away from the hustle and bustle of Tamale.

Finally we arrived at our destination: a plain, L-shaped building in a small compound. It was a Planned Parenthood of Ghana clinic that provides an integrated mix of family planning and other health education and services.

Despite its remoteness, we were greeted with as much enthusiasm and excitement as we felt in Tamale. About 200 people — village elders, mothers and fathers, grandmothers and grandfathers, children — had come out to show support for their clinic. They told us about the difference the clinic was making in their lives. In this isolated location, it was their only source of medical care.

But as we toured the facility, I happened to notice one person who wasn’t taking part in the excitement. Her name was Afia, and she sat very quietly, in a corner, on a hard wooden bench. A midwife was by her side.

Afia’s face was etched in pain, but her cries were muted. With quiet dignity, and few of the trappings that attend births in countries like my own, I found out she was in labor to deliver her first child.

As a mother myself, I knew how scared she must have felt. I also knew that in Ghana, for every 100,000 women who go into labor, 350 die giving birth or because of pregnancy-related complications. The statistics can be numbing.

Afia remained on my mind and two days later, I learned she had a lovely baby girl, and both mother and child were happy and most importantly, healthy.

I know that in the coming months and years, the clinic will help Afia keep herself and her baby healthy, and will give her the contraceptives she needs to plan her family and her future.

Our work does make a difference. This is what Family Planning 2020 is all about: reaching women, no matter where they live, with the information, services and supplies they need. Program by program, clinic by clinic, and woman by woman.

One year after the London Summit on Family Planning, I am pleased to report that FP2020 continues to build the foundations of a global movement and is accelerating progress towards achieving our goal of reaching an additional 120 million women with lifesaving contraceptive information, services and supplies by 2020.

Countries are championing the cause — over twenty governments have already made commitments and a few more are gearing up to do so. National, costed family planning plans are being drafted and implemented, new health laws are being passed and service delivery barriers are being addressed. Price-reduction agreements on long-acting, reversible contraceptive implants and the scale-up in delivery of discreet, injectable contraceptives ensures that millions of women will be able to access a range of family planning methods. We’ve improved relations with allies, built and strengthened new partnerships, and established our global governance framework. I am proud of what we’ve accomplished together.

And yet, I remain acutely aware that the work of FP2020 has only just begun. We have so much more to do to ensure that family planning remains front and center on the global development agenda. This will require even stronger international partnerships to uphold and guard the unified aspirations of millions of women and girls to chart their own future.

Women like Afia are depending on us to keep the promises we made one year ago at the London Summit. As we move forward into the second year of FP2020, I am convinced and confident that working together, we shall.

Page 6 of 42:« First« 3 4 5 6 7 8 9 »Last »