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From the Field in Vietnam: Small Loans Mean Big Changes for People Living with HIV

Vietnam’s mountainous Dien Bien Province, 500 km (about 310 miles) west of Hanoi, is home to the well-known battleground of Dien Bien Phu, where Vietnamese soldiers fought and won a decisive 55-day battle in 1954 against the French Union that brought an end to that war. Today, Vietnam is now engaged in another battle — against HIV/AIDS. And Dien Bien is one of Vietnam’s two provinces with the highest HIV prevalence.

Ms. Ca Thi Hinh, 32, a member of the Thai ethnic minority group in northern Vietnam, grew up in the province’s Tuan Giao district, an HIV hotspot. Born into a poor family, Hinh married in her early twenties. Her husband was also poor, and all they had was a temporary shelter. They both worked hard as hired laborers, saving as much as they could and looking forward to the moment when they could afford a decent house.

In her traditional costume typical of the Thai ethnic minority group in northern Vietnam, Hinh tells her story to a reporter from Vietnam Television with confidence, shining eyes and a radiant smile. Photo Credit: Richard Nyberg/USAID

In her traditional costume typical of the Thai ethnic minority group in northern Vietnam, Hinh tells her story to a reporter from Vietnam Television with confidence, shining eyes and a radiant smile. Photo Credit: Richard Nyberg/USAID

In 2007, Hinh’s husband was diagnosed with HIV when he was treated for a high fever, and died shortly after. Hinh then found out that she had contracted HIV from her husband, and the sky seemed to fall down on her. She could only gather her courage when she thought about her two small children. “I must live,” she thought. “My children need me to take care of them.”

As stigma and discrimination against people living with HIV/AIDS are still problems in Vietnam, people like Hinh have difficulty finding jobs, face unfair treatment in accessing social services and experience discrimination in healthcare and other settings.

Hinh looked to animal breeding as one option to earn an income, but she was turned down for a loan from a state-owned bank. Then she learned about M7/CFRC, a microfinance service provider supported by the USAID HIV Workplace Project. M7/CFRC staff trained her in financial management and gave her a microloan of $150. Adding $50 from her own savings, she bought two goats, one of which was pregnant. Three months later, her herd had grown to eight and she sold two goats for $215. With this money, she is able to support her children and her sister.

“I am very grateful for the support and care from the project. My children are now well-fed and educated, and I, myself, am more confident,” Hinh said. She hopes to have more goats soon, so that she can sustain her income.

Since 2008, the project, funded under the U.S. President’s Emergency Plan for AIDS relief (PEPFAR), has helped 1,400 people living with or affected by HIV in Vietnam. With microloans from the project, people like Hinh have found jobs and realized their dreams of running their own businesses. The success of the microfinance model for people living with HIV has encouraged local microloan providers to commit $1 million in loans to this target group.

The Government of Vietnam has also adopted the project’s microfinance models and is developing a new policy to provide loans to populations at highest risk of HIV in Vietnam.

Learn more about USAID’s work in Vietnam.

Like USAID Vietnam on Facebook and follow @USAIDVietnam on Twitter  for ongoing updates in the region. 

Photos of the Week: AID in Action: Delivering on Results

Driving human progress is at the core of USAID’s mission, but what do development results look like?

USAID is measuring our leadership in results — not dollars spent — implementing innovative, cost-effective strategies to save lives. Through investments in science, technology and innovation, USAID is harnessing new partners and young minds to transform more lives than ever before. Our new model for development embraces game-changing partnerships that leverage resources, expertise, and science and technology to maximize our impact and deliver real results.

Take a look at the Agency’s top recent and historical achievements in promoting better health; food security; democracy and good governance; education; economic growth, and in providing a helping hand to communities in need around the globe.

Read the stories behind the results in the special edition of FrontLines: Aid in Action: Delivering on Results.

Follow @USAID and @USAIDpubs for ongoing updates on the best of our results!

Video of the Week: Empowering Women Through Horticultural Innovations

The USAID Horticulture Project in Bangladesh aims to educate and train local farmers on innovative agricultural technologies that help diversify crops to increase nutritional value. With our partners the International Potato Center, AVRDC – The World Vegetable Center, BRAC and Bangladesh Agricultural Research Institute (BARI), we are working with local farmers to diversify diets and agricultural production systems with potato, orange-fleshed sweet potato, summer tomato, and nutritious indigenous vegetables. Meet some of the women farmers that have benefited from training in grafting tomato and producing sweet potato seedlings.

Learn more about our Mission of the Month: USAID Bangladesh.

Like USAID Bangladesh on Facebook and follow @USAID_BD and #MissionofMonth on Twitter for ongoing updates!

Preparing Youth for Employment

When it comes to preparing youth for employment, what strategies work best? As USAID’s recently-released State of the Field papers conclude, there is a need for more research and evidence on what types of interventions make a difference in strengthening youth livelihoods and employment. In Mali, Education Development Center’s (EDC) youth program  – PAJE-Nièta (Projet d’Appui aux Jeunes Entrepreneurs or Support to Youth Entrepreneurs Project) – is tracking several factors that affect youth livelihoods while highlighting issues and challenges that need to be better understood.

PAJE-Nièta has shown that young people are most eager for the business technical skills training and less for literacy and numeracy, so program delivery was adjusted to offer more business training earlier on. We also hope to learn which literacy and numeracy skills are most important for young people to have successful businesses in places where there is very little written local language.

Women in Mali using "Stepping Stone." Photo credit: EDC

Women in Mali improve literacy and numeracy skills through “Stepping Stone.” Photo credit: EDC

The PAJE-Nièta Project aims to increase access to local value chains by offering agro-enterprise development for 12,000 out-of-school rural youth. The project works in rural, often remote and difficult-to-access villages in Mali, where more than half of enrolled project youth have never been to school, while 80 percent are illiterate. Because of the major literacy gap, the project is offering literacy and numeracy training integrated with agri-business support services, business training, and audio instruction using a mobile phone platform created by EDC called “Stepping Stone.”

Results to date from the PAJE-Nièta Project show that 56 percent of youth who completed technical training have gone on to successfully start a micro-enterprise, with the proportion expected to rise as more data is received. Women outnumber male youth by 2 to 1 as participants, and in starting agriculture-based income generation activities. Young women, however, report lower profits with their businesses. Existing research on gender and agriculture suggests that results vary based on the resources available to men vs. women and inputs used. We are now studying these factors to learn more about gender differences within youth livelihoods, since this topic is not consistently analyzed under youth programs.

Another issue that has emerged in this youth work in Mali and elsewhere is the role of youth in family structures and how it may impact the benefits they gain. Our programs generally target youth with trainings and support based on the assumption that they are autonomous individuals and make decisions for themselves about what activities they engage in, or on whether they spend or save money. And yet, young people are a part of large and small family structures that influence their decisions  (particularly young women) about what work they do and when, as well as what they do with their earnings. This is important to consider when evaluating results from livelihood programs with youth; it is central to shaping the questions we ask and what we are measuring.

EDC is also tracking improvements in technical competence with respect to production techniques and business management; input costs; products sold; commencement, duration, and increase in the volume of both production and sales. We track literacy and math skills through exit interviews and performance tests and data on sales, production, and business management indicators. We are also assessing the use of mobile phones to increase literacy and numeracy.

The project seeks to prove the hypothesis that longer-term self-employment requires not just technical competence, but a commitment to entrepreneurial culture nurtured through mentoring. Toward that end, we conduct appraisals of youth microenterprises that are successfully managed for at least six months to determine the benefits realized by out-of-school youth and their families in the long term.

EDC’s work in Mali and around the world is contributing to a broader evidence base on youth livelihoods and employment with the goal of expanding opportunities for young people to support themselves and their families.

Nancy Taggart is a youth development specialist at Education Development Center, Inc. (EDC). She has worked in the field for 20 years, and is currently the Team Leader for EDC’s Youth Technical Team. EDC manages more than 200 projects in 30 countries. Visit www.edc.org.

New Mobile Clinics Take to the Road in Lesotho

This originally appeared on the Elizabeth Glaser Pediatric AIDS Foundation Blog.

Last month, the Elizabeth Glaser Pediatric AIDS Foundation (EGPAF) teamed up with the Lesotho Ministry of Health (MOH) to launch two mobile health care clinics that will provide HIV/AIDS and other health care services to residents in Lesotho’s rural communities. On July 11, EGPAF’s Chief Operating Officer (COO) Brad Kiley joined representatives from the Lesotho MOH and other high-level government officials at a ceremony to celebrate the new mobile units and how they will improve access to health care services to people throughout the country. The clinics are made possible thanks to generous support from the President’s Emergency Plan for AIDS Relief (PEPFAR) and the U.S. Agency for International Development (USAID).

Representatives from the Lesotho Ministry of Health, USAID, and EGPAF – including EGPAF COO Brad Kiley (in orange tie) – at a launch for two mobile clinics in Lesotho. Photo credit: EGPAF

Kiley noted that he is particularly proud of EGPAF’s success in Lesotho and is grateful for the kindness and support of the Government of Lesotho and the Ministry of Health. He also acknowledged and thanked USAID on behalf of the Foundation for its generous contributions to the key project of Strengthening Clinical Services in Lesotho.

Speaking at the same ceremony on behalf of the Health Minister, Principal Secretary to the Ministry of Health, Lefu Manyokole, said the mobile clinics come at the right time, when the Ministry is revitalizing primary health care and trying to strengthen the health system. He also commended the partnership and continued support EGPAF is giving to the Government of Lesotho.

He continued by emphasizing the MOH’s commitment to properly maintain and carefully coordinate the use of these mobile clinics so that they are effectively used for strengthening linkages and helping malnourished people in the region.

EGPAF will work with the MOH to provide integrated health services to patients in the remote areas of the mountainous districts of Thaba-Tseka and Mohale’s Hoek, where there is a high prevalence of HIV among pregnant women along with high rates of malnutrition among children and overall limited access to maternal, neonatal, and pediatric care. Each mobile clinic is equipped with two consulting rooms with collapsible examination couches, a metal stairway and emergency/wheelchair pathway, air conditioning, and built-in generators. Initially, services will include HIV/AIDS testing and treatment, prevention of the mother-to-child transmission (PMTCT) services, nutrition counseling, and other maternal and child health services.

These services are part of a larger effort by EGPAF and the Partnership for HIV-Free Survival (PHFS) and Nutrition Assessment Counseling Support (NACS) program to reduce malnutrition in the region, especially in HIV-positive women and children.

EGPAF has been active in promoting the use of mobile clinics throughout Africa. To learn more, click here.

To learn more about our work in Lesotho, click here.

Mapalesa Lemeke is Communications Officer for the Foundation, based in Lesotho.

Photo of the Week: Market Linkages in Bangladesh

Bangladesh

USAID creates market linkages to sustain traditional weaving of indigenous women. USAID’s environment activity, the Climate-Resilient Ecosystems and Livelihoods (CREL), improves diversified livelihoods that are environmentally sustainable and resilient to climate change. USAID has worked with the Government of Bangladesh and local communities to better manage and conserve Bangladesh’s natural resources and biodiversity since 1998. More resilient livelihoods and ecosystems will help Bangladesh meet development goals and move along the path to becoming a healthy, prosperous country. CREL is implemented by Winrock International.

Learn more about our Mission of the Month: USAID Bangladesh.

Like USAID Bangladesh on Facebook and follow @USAID_BD and #MissionofMonth on Twitter for ongoing updates!

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.

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)!

Video of the Week: USAID Launches “Promote” a New Initiative to Benefit Afghan Women

Last week, Administrator Shah at the United States Insittute for Peace, launched a five-year program targeting the education, promotion, and training of a new generation of Afghan women, aged 18-30.  Named “Promote,” the program’s goal is to increase women’s contributions to Afghanistan’s development by strengthening women’s rights groups, boosting female participation in the economy, increasing the number of women in decision making positions within the Afghan government, and helping women gain business and management skills. Learn more about “Promote”  in this clip from BBC World News.

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