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René Van Slate: “I’ve pretty much done everything that terrifies me… except for Ebola”

Morgana Wingard This is the first blog in our Profiles in Courage series in which photojournalist Morgana Wingard compiles snapshots and sound bites from our USAID and Disaster Assistance Response Team staff on the front lines of the Ebola response. Here she talks to a veteran in humanitarian disaster assistance, René Van Slate, who serves as a liaison between the military on the ground and the U.S. civilian team.
René Van Slate

René Van Slate
USAID Humanitarian Assistance Advisor to the U.S. Military

A veteran in humanitarian disaster assistance, René Van Slate is afraid of nothing… nothing except Ebola. She was on the ground after the flooding in Thailand in 2011, typhoon Bopha in the Philippines in 2012, the Republic of Marshall Islands drought in 2013, and typhoon Haiyan in the Philippines last year. Now, on her fifth disaster response team René explains her trepidation, “Ebola is microscopic, it’s covered in mystery and it’s incredibly deadly.” But, René is here with USAID facing her greatest fear on the front lines of the Ebola response in Liberia.

René touched down with the first crew from USAID’s Disaster Assistance Response Team (DART) at the beginning of August. Since then, she has liaised between the military on the ground and the U.S. civilian team, advising and coordinating logistics to best utilize military assets and personnel. Specifically, she is working on Operation Liberty with the Armed Forces of Liberia (AFL) supported by U.S. forces to build Ebola treatment units across Liberia.

One of the greatest challenges on the ground is that almost no one had ever dealt with an Ebola outbreak other than Médecins Sans Frontières (MSF) and those were much smaller and rural. “The whole humanitarian community is learning Ebola,” René says. “Though [building] an Ebola treatment unit is simple, like rocket science, it must be done perfectly every time.”

In an operation as large and complex as the current Ebola response, it takes a team of people working day in and day out processing requests to arrange for all the logistics to get materials transported, imported and delivered to where they are needed.

The best part of her job is days like today, when requests are fulfilled, referring to Thursday’s  arrival of 9,000 community protection kits—a joint effort of UNICEF, the Paul G. Allen Family Foundation and USAID—as part of the response to help Liberians fight Ebola. Each kit includes biohazard bags, soap, personal protective equipment, and gloves. They will be distributed to Ebola Community Centers across Liberia in partnership with UNICEF.
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(all photos by Morgana Wingard)

ABOUT THE AUTHOR

Morgana Wingard is a photojournalist documenting the many facets of the Ebola crisis in Liberia. All this week she will be guest posting from USAID’s instagram

Powering The Ebola Response: Monrovia’s Island Clinic

Morgana Wingard This is the first blog in our Daily Dispatches series in which we’ve teamed up with photojournalist Morgana Wingard, who is on the ground with USAID staff in Liberia documenting the fight on Ebola. Her photo series and blogs from the team will offer unique angles into the many facets of the Ebola story – from life inside a treatment center, to profiles of the health care workers battling Ebola from the front lines, to the many ways the epidemic is impacting the health, economy and future of the nation.

MONROVIA, Liberia—One of the saddest things about the Ebola outbreak in Liberia is the inability for many patients to get treatment. In Dolo Town recently, I watched a father carry his ailing son in a wheelbarrow to the clinic for treatment, but they did not have the capacity to help. He had been calling the government hotline for four days to no avail. A team of NGO workers proceeded to call the hotline again and a personal ambulance, but they also couldn’t get any help. All the treatment centers were full. In the end, the clinic sent him and his son home along with two other patients. Different versions of the same story have repeated across Monrovia for weeks. Liberians, trying to do the right thing, called the hotline and drove their loved ones to the hospital only to be denied entrance.

A father is devastated in Dolo Town after he was unable to get his son into an Ebola Treatment Unit (ETU) . It’s unclear whether he has Ebola as he can’t get to a facility for testing -- an all too common problem. The U.S. Government is helping build and staff several new facilities in Liberia. / Morgana Wingard

A father is devastated in Dolo Town after he was unable to get his son into an Ebola Treatment Unit (ETU) . It’s unclear whether he has Ebola as he can’t get to a facility for testing — an all too common problem. The U.S. Government is helping build and staff several new facilities in Liberia. / Morgana Wingard

After hearing too many of these stories as I have documented the unfolding Ebola crisis over past weeks, the opening of another Ebola treatment unit (ETU) was a huge relief. With the help of USAID, the Liberian Government and the WHO opened the 100-bed facility on Sunday, September 21. To power the treatment center, USAID provided two generators, amongst other supplies. These generators are vital to the functioning of the clinic by providing power for lights, pumps for water, and washing machines to clean scrubs worn by health care workers under their personal protective equipment (PPEs).

Miata, a nurse we met, said all the health care workers ran from nearby Redemption Hospital, the largest government-run hospital in Liberia, at first. A doctor and several nurses on staff became infected with Ebola and died as the outbreak was beginning in Liberia. But when a team of Ugandan health care workers arrived in Liberia who had fought previous Ebola outbreaks in their own country, they called them together for a training workshop.

“That workshop inspired me to come back. If we don’t help the patients, who will?” Now, she is not afraid because she can cover herself with personal protective equipment before she enters the “hot zone” to provide food for patients fighting the Ebola virus. This new Island Clinic facility is helping. But many more beds and qualified health care workers are needed to meet the needs of growing numbers of patients.

Qualified health care workers’ interested in volunteering can go to http://www.usaid.gov/ebola/volunteers for information.

Here are some shots I took on our trip to Island Clinic on Monday.

The entrance for health care workers going into Island Clinic

The entrance for health care workers going into Island Clinic, a new Ebola Treatment Unit that opened in Monrovia, Liberia on Sept. 21, 2014 and within one day, reached capacity. The building was a Doctors without Borders hospital during Liberia’s Civil War. It was neglected for several years until the government, with help from the World Health Organization, transformed it into a 100-bed clinic in response to the surge of patients needing care due to the Ebola crisis that is hitting Liberia especially hard. Many people are calling the battle against the Ebola epidemic a “biological war” and now these same facilities that were used during the country’s long Civil War are finding a new use as Liberia struggles to contain the crisis. USAID has provided two generators to the facility which are providing power for lights, pumps for water, and washing machines to clean scrubs worn by health care workers under their personal protective equipment.


A family waits at the entrance to the Island Clinic in Monrovia, Liberia

A family waits at the entrance to Island Clinic in Monrovia, Liberia, which was opened by the World Health Organization and the Liberian Ministry of Health in response to the surge of patients needing an Ebola Treatment Unit. Here, a health worker in protective gear tells the family to wait on the side as they open the doors for an ambulance to exit the facility. Before the facility opened on September 21, ambulances and patients arrived at the gates waiting to be admitted. Just a day after opening, the clinic is already at capacity. USAID has provided two generators and other supplies to equip the facility with life-saving care.


Health care workers put on personal protective equipment before going into the hot zone at the Island Clinic in Monrovia

Health care workers put on personal protective equipment before going into the hot zone at Island Clinic, in Monrovia, Liberia on Sept. 22, 2014. The 100-bed clinic opened on Sept. 21, and within one day it is already at capacity after approximately 100 Ebola patients were moved from the nearby Redemption Hospital and ambulances brought other Ebola-stricken patients from the community. There are still more patients on the way. The facility was set up by the World Health Organization and Liberia’s Ministry of Health in response to the surge of patients needing an Ebola Treatment Unit. USAID has provided two generators and other supplies the facility.


Hygienists at the ebola treatment unit at Island Clinic in Monrovia wash health workers' scrubs

Hygienists at the ebola treatment unit at Island Clinic in Monrovia wash health workers’ scrubs, a vital part of the operation at the new clinic, which opened September 21, 2014. Health workers at the clinic must follow extensive protocol to protect themselves. All scrubs worn under their personal protective equipment and shoes must be washed thoroughly in chlorine water and then with soap. While we were at Island clinic, one of the health workers told me why she was working here: “If we don’t help the patients, who will?” She said she is not afraid because she can cover herself with personal protective equipment before she enters the “hot zone” to provide food for patients fighting the Ebola virus.


A patient lies in a bed at the newly opened Island Clinic in Monrovia

A patient lies in a bed at the newly opened Island Clinic in Monrovia, Liberia on Sept. 22, 2014. The patient is getting an intravenous treatment – a crucial part of treatment for Ebola because the virus quickly dehydrates those it infects. However, using IV is also considered risky for health workers if they do not take proper precautions and not all treatment centers are using them. At the Island Clinic, a concrete wall and glass window offers those outside the clinica sobering view into the patient area. While I am standing less than a foot from this man, the perception is that I’m peering into a restricted and isolated world.

(All photos by Morgana Wingard)


ABOUT THE AUTHOR

Morgana Wingard is a photojournalist documenting the many facets of the Ebola crisis in Liberia. All this week she will be guest posting from USAID’s instagram

An Unprecedented Response to the Ebola Crisis

The Ebola crisis has quickly overwhelmed West Africa’s health system: new Ebola victims fill medical facilities faster than new ones can be established

The Ebola crisis has quickly overwhelmed West Africa’s health system: new Ebola victims fill medical facilities faster than new ones can be established. / Morgana Wingard

Today the world is facing the largest and most-protracted Ebola epidemic in history. Yesterday, at the Centers for Disease Control and Prevention, President Obama declared the Ebola epidemic in West Africa a top national security priority and announced a clear, comprehensive, and global strategy to stop the outbreak.

“Faced with this outbreak, the world is looking to us, the United States, and it’s a responsibility that we embrace. We’re prepared to take leadership on this to provide the kinds of capabilities that only America has, and to mobilize the world in ways that only America can do.  That’s what we’re doing as we speak.”

The United States has been combating the Ebola epidemic since the first cases were reported in March, and we have expanded our efforts and increased personnel in the region as the crisis has unfolded. More than 120 specialists from across the U.S. Government are on the ground in West Africa to prevent, detect, and stop the spread of this disease. USAID deployed a Disaster Assistance Response Team—or DART—to the region to oversee and coordinate the U.S. response, providing logistics, planning, program, and operational support to the affected countries; drawing forth critical assets and resources from several U.S. departments and agencies.

This crisis continues to escalate exponentially and requires an intensified speed and scale of response to address a rising rate of infection. It has quickly overwhelmed West Africa’s health system: new Ebola victims fill medical facilities faster than new ones can be established. Heroic doctors, nurses, and health workers are stretched to their personal and professional limits.

Against this landscape of overwhelming despair, there is hope. As the President declared in Atlanta:

“The world knows how to fight this disease. It’s not a mystery. We know the science.  We know how to prevent it from spreading. We know how to care for those who contract it.  We know that if we take the proper steps, we can save lives. But we have to act fast.“

That’s why yesterday afternoon President Obama announced a significant expansion of our response.

In an Ebola crisis, chlorine is used to disinfect areas that people infected with the virus may have come in contact with.

In an Ebola outbreak, chlorine is used to disinfect areas that people infected with the virus may have come in contact with. / Morgana Wingard

Through a whole-of-government approach, we’re mounting an aggressive U.S. effort to fight this epidemic and have devised a clear strategy with four key pillars to stop this epic crisis:

  • Controlling the epidemic;
  • Mitigating second-order impacts, including blunting the economic, social, and political tolls;
  • Coordinating the U.S. and broader global response; and
  • Fortifying global health security infrastructure in the region and beyond.

Our goal is to enable the most effective international response possible, using our government-wide capabilities to fight the epidemic on a regional basis. Our current efforts have focused on controlling the spread of the disease—bringing in labs for specimen testing; supporting the construction and management of Ebola treatment units; airlifting critical relief supplies; strengthening emergency response systems of the affected governments; supporting burial teams who are safely managing human remains to prevent transmission; and spearheading mass public awareness campaigns with communities to describe how to prevent, detect, and treat Ebola.

To complement these efforts, the President also announced the launch of the USAID-led Community Care Campaign, which will aim to provide every family and every community the critical information and basic items that can help protect them from this deadly virus.  Information will stress the importance of sick families members seeking help at a clinic or Ebola treatment unit and how to exercise basic infection control that can be life-saving, such as washing hands or not washing their dead relatives. Items like soap and chlorine can reduce transmission. Women are especially important to reach given their traditional role in washing the bodies of dead relatives — a prime transmission route of the virus. To reach people with low literacy, the campaign will train health volunteers and community leaders on how best to verbally provide messages to their neighbors.

Partnering with the affected countries, the U.N. Children’s Fund (UNICEF), the Paul G. Allen Family Foundation, and organizations on the ground, USAID will initially target 400,000 of the highest risk households in Liberia with this vital training and important tools.

The campaign is also rooted in a sobering reality. Half of all people who get sick don’t seek treatment at hospitals or Ebola treatment units. Many are frightened by rumors and deterred from traveling to hospitals where their friends and neighbors are taken and never return. A complex array of traditional beliefs and practices mean many of those who should seek help choose to stay in their homes – often putting those family members who care for them at risk.

The Ebola crisis is wreaking havoc on West Africa’s health care system. USAID is focused on supporting the construction and management of Ebola treatment units; airlifting critical relief and medical supplies; training health care workers; strengthening emergency response systems of the affected governments; and supporting public messaging with communities on how to prevent, detect and treat Ebola.

The Ebola epidemic is wreaking havoc on West Africa’s health care system. USAID is focused on supporting the construction and management of Ebola treatment units; airlifting critical relief and medical supplies; training health care workers; strengthening emergency response systems of the affected governments; and supporting public messaging with communities on how to prevent, detect and treat Ebola. / Morgana Wingard

This week, working alongside the Paul G. Allen Family Foundation, we will airlift 50,000 USAID-funded home health care kits to be delivered to some of the most isolated and vulnerable communities in Liberia. We will simultaneously work with every part of society to educate people on how to prevent and detect Ebola through mass public awareness campaigns supported by radio, text, television and community announcements. As we scale up our response, the only way the virus will be controlled is if we make concerted efforts to reach every community, and every home in the affected areas.

We know tough months lie ahead. It will require a coordinated effort by the entire global community to help stem this terrible public health crisis. But every outbreak of Ebola in the last 40 years has been stopped, and this one will be, as well.

ABOUT THE AUTHOR

Nancy Lindborg is the USAID Assistant Administrator for the Bureau for Democracy, Conflict and Humanitarian Assistance

5 Things You Didn’t Know About Female Condoms

Langton Ziromba promotes female condoms in the casual and friendly space of his barbershop. / UNFPA

Langton Ziromba promotes female condoms in the casual and friendly space of his barbershop. / UNFPA

Since the first female condom hit global markets in 1992, the female condom has become more effective, more comfortable, and more accessible. Today, a variety of female condom products are sold worldwide, including the FC2, the Cupid, and the Women’s Condom. With more options for keeping yourself and your partner protected from HIV and STIs, there’s a lot to celebrate this Global Female Condom Day.

FC2 Female Condom Packaging

New packaging released for FC2. / The Female Health Company.

While the female condom has come a long way in user acceptability, user rates are still below targets needed to achieve an AIDS-free generation and prevent HIV and STI transmission among people of all genders. As awareness about the multipurpose protection benefits of the female condom grows, global demand is increasing.

In honor of Global Female Condom Day, read and share these five facts about female condoms, and help ensure that we continue celebrating successes in advancing sexual and reproductive health for all.

1. Best Multi-purpose Protection: According to research, the FC2 can be 97 percent effective in reducing risk of sexual transmission of HIV. The female condom is also approximately 80 percent effective in preventing  pregnancy. As a multi-pronged protection method, the female condom can transform women’s sexual and reproductive health lives and provide them with a means of taking control over their health, especially in circumstances where their choices are limited.

2. Global Appeal: The United States Government through the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR) is one of the largest procurers of female condoms worldwide. In 2003, PEPFAR supplied roughly 1.1 million female condoms worldwide. By 2009, global shipments had increased to almost 15 million per year. In 2012, a record 32 million female condoms were distributed in total by the international donor community. Today, the female condom is available in over 100 countries.

3. Becoming More Popular: In the past, many have been reluctant to use the FC2, or other female condom styles, claiming they feel unnatural. Subsequent designs made of latex can offer a natural feel for male partners.

4. Easy To Use: Female condoms can be inserted up to 8 hours prior to sex, giving people even more control over their bodies. For detailed instructions on proper usage, see here.

5. They Keep Getting Better!: In 2013, the Gates Foundation launched a $1 million award to create the next generation of more user-friendly condoms. Among the 11 proposed designs, is a new female condom infused with air that would be faster and easier to insert. Other innovations include the 100 percent silicone Origami female that is made of a single accordion-like piece that can be washed and reused. Several of these promising designs are set to reach the market in 2015.

ABOUT THE AUTHOR

Clancy Broxton is the Senior Social Marketing & Commodities Advisor for USAID’s Office of HIV/AIDS and Rahel Beigel is a Global Health Fellows Program intern working with Clancy on condoms.

An Opportunity of 300,000 Lifetimes

“Healing is a matter of time, but it is sometimes also a matter of opportunity.” The Greek physician Hippocrates wrote this in about 400 BC. Of course, when Hippocrates practiced medicine, opportunities to heal were scarce as he and his peers understood relatively little about anatomy and physiology, much less biomolecular science. In Hippocrates’ era, some percentage of young children were expected to succumb to illness. Over the last 2,000 years, however, developments in medical science have allowed for the previously unthinkable. The collective brilliance and hard work of scientists and healers have ensured that many of the maladies that afflicted Hippocrates’ patients took a one-way trip to the history books.  Children, for the most part, can be expected to reach adulthood.

Alas, some exceptions stubbornly remain.

There is no clearer example than pediatric HIV. A single generation has seen the rise of a devastating epidemic and, though there have been breakthroughs in the fight against the virus, 3.2 million children currently live with the virus and an estimated 700 children are infected daily. The recent, sudden viral rebound in the “Mississippi baby,” the first child believed to be functionally cured, was the latest punch to the gut in the long, drawn out brawl to protect children from the virus. In low-resourced regions, children living with HIV are often among the last to be tested and treated. Initiating children on treatment early, which allowed the Mississippi baby to remain virally suppressed for years, is exceptionally rare.

A baby receives life-saving drugs. / Anna Zeminski, AFP / Getty Images

A baby receives life-saving drugs. / Anna Zeminski, AFP / Getty Images

Now for some good news. Earlier this month, as part of the U.S.-Africa Leaders Summit, the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR),in partnership with the Children’s Investment Fund Foundation (CIFF), launched Accelerating Children’s HIV/AIDS Treatment (ACT). ACT is an ambitious $200 million initiative to double the total number of children receiving life-saving antiretroviral therapy (ART) across 10 priority African countries over the next two years. This investment will enable 300,000 more children living with HIV to receive life-saving ART.

At the onset of the HIV epidemic in the early 1980′s, an HIV diagnosis was equivalent to a death sentence. Failing to treat a child remains just that, as half die by 2 years of age. Up to three people die of AIDS every minute and an estimated 190,000 children died of AIDS in 2013 alone.

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An HIV-positive mother holds her child after visiting an HIV clinic. For children who are born HIV-positive, life-saving antiretroviral therapy is critical to protecting their health. / AFP

Hippocrates was right: Healing is indeed both a matter of time and opportunity. Time does not heal HIV, however, and deaths continue to mount, a disproportionate number of them among children.

So, now is the time to act. Thanks to PEPFAR and CIFF, we have an unprecedented opportunity to do just that.

ABOUT THE AUTHOR

Dr. Benjamin Ryan Phelps is a Medical Officer who focuses on Preventing Mother-to-Child Transmission of HIV (PMTCT) and Pediatric AIDS. Follow him at @BRPhelpsMD.
Joella Adams is a Global Health Fellows Program intern working with PMTCT programs.

On the Frontlines of the Ebola Response: an Inside Look at a Program to Help the Grieving

The West African Ebola outbreak is the worst outbreak in history, affecting four countries. The U.N. World Health Organization declared it an international health emergency

The West African Ebola outbreak is the worst outbreak in history, affecting four countries. The U.N. World Health Organization declared it an international health emergency / Christina Goldsmith, CDC

In Liberia, a country gripped by Ebola, the outbreak has not only taken its toll on health care workers but also on the professionals who comfort the grieving.

“The outbreak of Ebola was very shocking and overwhelming to our country,” said Jestina Hoff, a counselor with the Liberian Red Cross. “It brought a lot fear.”

As a counselor with the Liberian Red cross, Jestina Hoff must find ways to comfort Ebola victims or their families without getting close to them

As a counselor with the Liberian Red cross, Jestina Hoff must find ways to comfort Ebola victims or their families without getting close to them. / Carol Han, USAID/OFDA

The outbreak has also hampered Hoff’s ability to do her job. “As a counselor, I talk to parents who lost a child or to someone who has gotten sick with the virus,” said Hoff. “They are feeling so discouraged, and I have to help them accept the situation and comfort them, but without touching them.”

Francesca Crabu, a clinical psychologist with the International Committee of the Red Cross, explained that having close contact with those who are grieving is key to providing psychosocial support. But in Liberia and other parts of Western Africa, preventative measures require people to stay at arm’s length from each other.

“Here in Liberia, it is very painful that you cannot shake hands. If somebody is dying I cannot hug you,” said Crabu.

To make matters worse, once Ebola claims a life, the body is taken immediately, before families have time to mourn their loss, according to Eliza Yee-lai Cheung, a clinical psychologist with the Hong Kong Red Cross.

Eliza Yee-lai Cheung (right) a clinical psychologist with the International Federation of the Red Cross, listens as counselors in Monrovia share stories about helping families cope with Ebola

Eliza Yee-lai Cheung (right) a clinical psychologist with the International Federation of the Red Cross, listens as counselors in Monrovia share stories about helping families cope with Ebola. / Carol Han, USAID/OFDA

“They cannot hold a memorial service or burial according to their culture,” said Cheung. “That’s why it’s very hard for them.”

To give psychosocial counselors the tools to help grieving communities, the USAID Ebola Disaster Assistance Response Team (DART) is partnering with IFRC in Monrovia, Liberia’s capital city. Among other things, the DART and the International Federation of Red Cross and Red Crescent Societies are working to raise public awareness of Ebola’s mode of transmission, teach disease prevention practices to communities, and train health workers and volunteers.

Training materials passed out to counselors will help them train others in the community

Training materials passed out to counselors will help them train others in the community / Dagny Olivares, CDC

In a classroom, 19 people—counselors with the Liberian Red Cross, staff with NGOs and social workers with the Liberian Ministry of Health & Social Welfare—are learning from Crabu and Cheung how to organize culturally appropriate activities to help families cope with their loss. They are also taught ways to keep themselves safe from the virus and how to provide support to each other. This group will then go on to train others in affected communities with the hopes that such efforts will help the country come to grips with Ebola.

“It’s overwhelming,” said Hoff. “But we have a goal. I have a goal. We have to serve our country. We need somebody to take a step to help others move forward. It’s scary, but there’s hope.”

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.

If You ‘Let Girls Learn,’ You Save Lives Too

letgirlslearn_rev2

Oppression and prejudice toil in a cage of ignorance and cruelty.  Before the U.S. Civil Rights movement altered the course of history, Jim Crow laws and terror imposed segregation and licensed discrimination, casting a pall of shame over America.

Today, the inhumane degradation and culturally sanctioned abuse of girls in many parts of the world is a shockingly similar shame. Denied the most basic universal human rights, girls have limited access to health care, nutrition, education and job skills training, as well as productive resources, such as water, land and credit.

The kidnapping of 300 Nigerian girls by the extremist group Boko Haram focused global attention, issuing a clarion call that girls’ education and health are civil rights worth fighting for, leading to benefits, not only for girls, but for entire communities and nations. In low income countries, mothers who have completed primary school are more likely to seek appropriate health care for their children. A child born to a literate mother is 50 percent more likely to survive past the age of 5.

  • In low income countries, mothers who have completed primary school are more likely to seek appropriate health care for their children.
  • A child born to a literate mother is 50 percent more likely to survive past the age of 5.
  • Women with some formal education are more likely to seek medical care and ensure their children are immunized.
  • Women with some formal education are more likely to be better informed about their children’s nutritional requirements, and practice better sanitation.
  • An educated girl is three times less likely to contract HIV.

Segenet Wendawork was 5 years old when her mother died. After her father moved away, she bounced around, living with her grandmother for a while, then an aunt who kept her home from school to help with chores.  Thanks to a USAID scholarship program, Segenet was able to return to school in Ethiopia and complete her education. “Before the scholarship, I was unable to dream about the future,” she said.

Sixty-two million girls are not in school, and are also unable to dream about their future. And millions more are fighting to stay in school. The U.S. Government invests $1 billion each year through USAID in low-income countries to ensure equitable treatment of boys and girls, to create safe school environments, and to engage communities in support for girls’ education.

According to the Working Group on Girls (WGG), a coalition of over 80 national and international non-governmental organizations, schoolgirls of all ages report sexual harassment and assault, ranging from gender discrimination to rape, exploitation and physical and psychological intimidation in school.

Last week, a new effort was launched by the U.S. Government, and led by USAID, to provide the public with meaningful ways to help all girls get a quality education. Let Girls Learn aims to elevate a conversation about the need to support all girls in their pursuit of a quality education. In support of the effort, USAID also announced over $230 million for new programs to support education around the world.

Thomas Staal, a senior leader with USAID, said education is essential to fight poverty and all its corollaries: hunger, disease, resource degradation, exploitation and despair. “Women are the caretakers and economic catalysts in our communities. No country can afford to ignore their potential.”

Since education level has the greatest effect on the age at which a woman has her first birth, and adolescent mothers are more likely to die in childbirth, education both empowers young people directly and affects family planning choices and labor force participation.

 “Education is essential to fight poverty and all its corollaries.” In this photo, school children in Haiti. / Devon McLorg, USAID

“Education is essential to fight poverty and all its corollaries.” In this photo, school children in Haiti. / Devon McLorg, USAID

Conversely, a healthy start in life and good nutrition are essential for children to thrive, develop and spend more time in school. Last month, USAID launched a new global nutrition strategy  aimed at reducing the number of chronically malnourished or stunted children by at least 2 million over the next five years. Every year, under-nutrition contributes to 3.1 million child deaths—45 percent of the worldwide total.

In the strategy, USAID is prioritizing the prevention of malnutrition given the irreversible consequences of chronic under-nutrition early in life. Under-nutrition inhibits the body’s immune system from fighting disease and impedes cognitive, social-emotional and motor development.

In addition to focusing on good nutrition in the first 1,000 days for mother and child, USAID is also saving newborns from severe infections, protecting young children from the risks of diarrhea, pneumonia and malaria, and helping women space the births of their children to protect their health and that of their children.

This week, USAID, the governments of Ethiopia and India, in collaboration with UNICEF, the Bill & Melinda Gates Foundation, and others will hold a high level forum to take stock of recent efforts aimed at reducing child and maternal deaths and plot a new course that will ensure progress continues.

USAID will refocus the majority of our maternal and child health resources toward specific, life-saving tools in 24 countries where the need is greatest and empower our partner countries to lead with robust action plans and evidence-based report cards to save an unprecedented number of lives by 2020.

USAID Assistant Administrator Ariel Pablos-Mendez said by coupling family planning investments with policies supporting child survival, girls’ education and job creation – especially those targeting women – countries can be positioned to realize substantial economic growth that lifts everyone out of poverty.

Doing so will allow girls and boys to follow their wildest hopes and dreams and live productive lives.

ABOUT THE AUTHOR

Chris Thomas is a communications advisor in the Bureau for Global Health. Read more from the author in the latest FrontLines, which features articles about the Agency’s work in maternal and child health: In Health Research Fueled by USAID Is Fielding Innovative Solutions, he writes about innovative, cost-effective and life-saving health care solutions whose research and development were aided by USAID; and in Your Voice: Frontline Health Workers are the Unsung Heroes of Global Health Progress, he describes just how essential community health workers are to rural and other underserved communities in developing nations.

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