USAID Impact Photo Credit: USAID and Partners

Archives for Health

Taking a Stand Against Violence Now

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

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

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

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

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

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

One out of four.

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

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

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

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

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

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

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

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

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

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

Said one patient:

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

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

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

Helping Women Avoid HIV Infection and Transmission

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

HIV testing at Ukrainian clinic Photo Credit: USAID/Ukraine

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

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

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

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

Fighting HIV With Circumcision

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

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

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

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

USAID at Forefront of HIV Prevention

On Monday, I convened a meeting to determine the next steps following the success of the CAPRISA trial, which showed the world that a microbicide could help prevent HIV transmission in women. Together with both public and private sector colleagues, we defined a way forward over the next two years to expedite licensure and prepare for the introductory phase of the gel or other ARV-based microbicides. I will also convene an additional meeting  of technical experts in the field to discuss how to aggressively roll out microbicide treatments to those most in need.  We have a shared responsibility to build on the successes achieved to date by making smart investments that will ultimately save more lives in the future.

Pic of the Week: Commemorating 2010 World AIDS Day

Woman and boy in MozambiqueEighty percent of Mozambique‘s people live in villages and must walk on an average 12 kilometers to reach a health clinic. Here, a woman and her daughter hold the anti-AIDS medicine that keeps them alive. They worried that neighbors would see the medicine and know they had the disease. Photo is from Ben Barber/USAID.

Saving Lives Through Smart Investments

This originally appeared on Dipnote.

As we approach World AIDS Day, many are asking difficult questions about the way forward on global AIDS. The questions are not about whether lives are being saved from the devastation of AIDS, because they are — by the millions. But some wonder whether we can continue to maintain our strong commitment and make dramatic progress when the global economy is under such strain. It’s a reasonable question, and one motivated by genuine concern for those we serve. Let us be clear: the answer is that we can, and we are fully dedicated to continuing in our fight against HIV/AIDS.

Through a range of actions, the Obama Administration is demonstrating that the U.S. commitment remains firm, even in these challenging economic times. The Administration’s budget request for the U.S. President’s Emergency Plan for HIV/AIDS Relief (PEPFAR) this year is the largest in any President’s budget to date. We are grateful for the strong foundation of success that President George W. Bush and a bipartisan Congress established when they launched PEPFAR. Building on that foundation, during President Barack Obama’s tenure PEPFAR has continued to expand, greatly increasing the number of lives saved from this destructive pandemic. Tomorrow, on World AIDS Day, we’ll announce our latest results, which will show continued, dramatic progress in saving lives devastated by HIV/AIDS.

We’re also proud of the partnerships that we built with the Global Fund to Fight AIDS, Malaria and Tuberculosis and with individual country governments. The Obama Administration recently announced the first-ever multi-year pledge to the Global Fund of $4 billion — a significant 38 percent increase.

Under PEPFAR, the U.S. government is also focused on doing business more efficiently and effectively. Years of experience in the field have taught us how to better use every dollar invested in battling AIDS. This means we are getting a bigger bang for the buck — allowing us to do more to fight not only HIV/AIDS, but other global health issues that impact communities affected by HIV. It means that our yardstick for measuring success is not dollars invested, it’s lives saved. Simply put, we’re focused on making smart investments that improve and save more lives.

Let’s look at a few examples.

We’re saving lives and money by using more generic drugs. Recognizing that one of the biggest hurdles to rapid treatment scale-up was the high price of antiretroviral drugs, PEPFAR worked with the U.S. Food and Drug Administration to bring more generics to market. By 2008, generics accounted for almost 90 percent of the 22 million antiretroviral drug packs purchased, increasing from 14.8 percent in 2005, and resulting in an estimated cumulative savings of $323 million.

We’re successfully implementing programs to prevent mother-to-child transmission. Prevention of mother-to-child transmission is one of the most effective — and cost-effective — interventions for HIV. By focusing on preventing mother-to-child transmission, Botswana and parts of South Africa have had extraordinary success, reducing the likelihood of infant infection to levels similar to those found in the United States, and reducing the significant costs associated with new infections. Accordingly, PEPFAR’s Five-Year Strategy set goals to reach 80 percent of pregnant women with HIV counseling and testing, and to provide antiretroviral prophylaxis or treatment, as appropriate, to 85 percent of pregnant HIV-infected women in PEPFAR countries.

We’re changing the way we deliver medicines. We have become more efficient in shipping needed medicines in a timely fashion by using water and land delivery systems instead of air freight, reducing costs by as much as 90 percent. In 2009, sea freight charges for products PEPFAR moved through the Supply Chain Management System (SCMS) were $520,000, while moving the same volume by air would have cost an estimated $3.8 million. Similarly, road freight charges for the product PEPFAR moved through SCMS were $395,000, while to move the same volume by air would have cost an estimated $953,000.

Last, but not least, medical male circumcision promises dramatic impact on prevention efforts. Medical male circumcision is an ideal HIV prevention investment for countries and donors, as it is a one-time intervention that provides lasting prevention benefits. The majority of the expenditure required to saturate a country with high levels of adult male circumcision takes place in the first 1-3 years, depending on the speed of the program, and expenditures drop precipitously following this initial investment to support neonatal and adolescent boys. Scaling up male circumcision to reach 80 percent of adult and newborn males in 14 African countries by 2015:

- Could prevent more than 4 million adult HIV infections over 15 years (2009 – 2025)

- Could result in cost savings of $20.2 billion between 2009 – 2025 with an overall investment of approximately $4 billion

We’ve had great success in the fight against HIV/AIDS, but the battle is far from over. The goal now must be to build on that success and continue to be smart about the investments we make.

Giving Girls a Chance Against HIV/AIDS

In Malawi, Chimwemwe Banda was abandoned by her parents when she was a young girl; she and her sister were left to take care of themselves. Without money to pay for basic needs or tuition, Chimwemwe was forced to drop out of school. In hopes of improving her situation, like many girls in Malawi, she entered into an early marriage— Chimwemwe was only 15 years old on her wedding day.  Soon after she married, Chimwemwe realized that life was not going to get better just because she had a husband.

Chimwemwe Banda is one of the many girls who has benefited from a Go Girls! community intervention. Photo Credit: Hilary M. Schwandt/AFP

Early marriage, along with behaviors such as transactional and intergenerational sex, contributes to girls’ vulnerability to HIV. Chimwemwe is just one of the 600 million girls living in poverty who are at increased risk of contracting HIV/AIDS. Similarly, girls who are orphans, early school leavers, socially marginalized, and/or migrants have a heightened vulnerability to the virus. Worldwide, women and girls bear the brunt of the HIV/AIDS epidemic; according to the World Health Organization, AIDS is the leading cause of death among women aged 15-44 worldwide.

Socio-economic factors like poverty, along with gender norms such as expectations around early marriage, can lead to increased vulnerabilities that discourage girls from asserting control over the timing and circumstances of sex, including negotiating protection against HIV and other sexually transmitted infections (STIs).

Most interventions to date have focused on individual-level behavioral change without sufficient consideration of the structural factors that fuel the epidemic. USAID is working to address this imbalance through the Go Girls! Initiative.

In fact, it was Go Girls! that stepped in to help Chimwemwe. With their assistance Chimwemwe dissolved her marriage. Her village developed a community mobilization team that recognized the detrimental effects of early marriage on girls, and advocated delaying marriage as a strategy for maintaining girls’ health and encouraging their educational pursuits.

Since the end of her marriage, Chimwemwe returned to school. She now leads a happier life and enjoys going to school everyday. “I feel good about being back in school,” she said. “If I had the opportunity to advise other girls, I would tell them not to marry early but to continue schooling because school is good. I am working hard at school every day so that I may have a brighter future.”

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

World AIDS Day 2010

On World AIDS Day, we commit to build upon our successes and continue to make smart investments that will ultimately save and improve millions of lives.  Join us this week as we highlight some of our successes and share stories of those helped by our programs.

If you’d like to learn more about the Go Girls! program, including how to access free copies of the Go Girls! program materials, contact ghcommunicationsteam@usaid.gov

 

Page 43 of 55:« First« 40 41 42 43 44 45 46 »Last »