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No Mountain Too High: Saving the Snow Leopards, Ecosystems and Communities of High Asia

Today is Wildlife Conservation Day, and USAID’s missions around the world are raising awareness of the interconnectedness between human and wildlife welfare in developing countries.

Here in Kyrgyzstan, we announced on Saturday the launch of a new four-year project focused on preserving the ecosystems of Asia’s mountainous regions, benefiting its people and environment. Entitled “Conservation and Adaptation in Asia’s High Mountain Landscapes and Communities,” the project will be implemented in close partnership with our partners: the World Wildlife Fund (WWF) and the Snow Leopard Trust. It will operate not only in Kyrgyzstan but also in Bhutan, India, Mongolia, Nepal and Pakistan, and build alliances across all countries with snow leopards.

Officials from 12 countries attended a three-day conference on the snow leopard in Bishkek, Kyrgyzstan on December 1-3, 2012. Photo Credit: USAID

The snow leopard is a focus of this project for three major reasons. First, these endangered animals face significant threats to their habitats in the context of a changing climate and increased human activities. Second, animals like the snow leopard have great popular appeal, drawing attention to the challenge of conservation and providing a rallying point to benefit entire ecosystems, including the humans who depend on these ecosystems for their livelihoods. Finally, snow leopards are indicative of the health and vitality of entire ecosystems across their range. They are an integral part of the ecosystems in which they live, and the well-being of countless other species and human communities depends on the health of those ecosystems.

The primary goal of the new USAID project is to stimulate greater understanding and action on the environment, by helping conserve this iconic and endangered species, as well as by connecting snow leopard conservation to a broader set of environmental, economic and social issues with consequences for Asia’s future sustainability, including local livelihoods, water and food security, and climate change adaptation. In Kyrgyzstan, the project will include a snow leopard population survey considering recent and predicted changes in key habitats, support to anti-poaching teams, and engagement in species conservation activities through conservation education and training with local communities.

It was not a coincidence that the project was announced in Kyrgyzstan. The President of the Kyrgyz Republic, Almaz Atambayev, and other senior Kyrgyz officials have shown great initiative in bringing this important topic to the international level, as demonstrated by the three-day conference on the snow leopard which ended on December 3, attended by representatives from 12 countries and NGOs from across the world. We hope this is just the beginning of our joint work with local and international partners on this challenging task to bring positive impact on both wildlife and the mountain communities of Asia.

Helping Families Build Resilience and a Better Future for Kids

Carolyn Miles and Moussa in Diema, Mali in August 2012. Photo Credit: Save the Children

Whenever I’m asked to describe the scale of the hunger crisis in the Sahel, I see Moussa’s face.

I met him in August during a trip to Mali when he was two months old, but he was so small and frail that I worried he would die in my arms. That day, Moussa’s mother rushed him to an emergency clinic where he received medicine and treatment for malnutrition, and he improved within days. What’s shocking about this story is not how narrowly this little boy escaped death—but that he was one of the lucky ones.

This year, more than 18 million people, including millions of children, struggled during a hunger crisis in the Sahel for the fourth time in a decade. Too many children struggle repeatedly because families don’t have the resources to recover from previous crises, restore their livelihoods or build savings in preparation for the next crisis. Families and communities must be resilient so they can cope with the shock of a crisis and help their kids survive and thrive, even in challenging times.

Last week in Vietnam, I saw the flip side of drought—how too much water causes flooding and landslides that turn poor children’s lives upside-down. With the long-term impact of climate change looming on the horizon, we must sustainably reduce families’ vulnerability to these and other hazards that threaten their ability to bounce back.

We will never be able to stop shocks from happening, but we can give families the tools they need to protect children in the short- and long-term. To do this, we must tackle the root of the problem by developing resilience in chronically vulnerable areas when a crisis is not at hand.  In parallel, we must increase the capacity of all levels of society—household, community and national—to cope when disaster strikes.

USAID’s new policy and program guidance (PDF), “Building Resilience to Recurrent Crisis, is an important step in helping families in vulnerable settings build pathways to a brighter future.  This policy will enable USAID and partners—including Save the Children—to better coordinate emergency response and development assistance, decreasing the need for repeated assistance in the same affected areas while increasing families’ ability to face and overcome future crises.

Recently, USAID has impressively reorganized itself to meet the challenges of resilience, including forming country-led strategies, learning agendas and joint planning—all of which will help create a more hopeful future for children. We encourage the U.S. government to continue its leadership role in the Global Alliance for Action for Drought Resilience and Growth and the Champions for Resilience, and invite others in the development community to join in this opportunity for families.

A child’s future shouldn’t depend on luck. For every Moussa who received care just in time, there are countless others who did not. We can’t reach every child when a crisis hits. But we can give parents and communities the tools they need to help kids weather the storm, stay safe and healthy, and build a better future for the next generation.

Resilience: Safety Net for Reducing Hunger and Malnutrition

David Beckmann is President of Bread for the World. Photo Credit: Bread for the World

Over the last month, we have watched communities along the New York and New Jersey coastline begin to rebuild from the devastating impact of Hurricane Sandy. It is a reminder that we are all vulnerable to natural disasters that can happen at any time. How communities survive and recover from these shocks depends very much on their resilience – their ability to cope and their systems for preparing, responding and rebuilding. In the United States, these systems are already in place and, for the most part, function well. This is not the case in many low-income countries.

Year after year, we see poor communities in developing countries deal with the effects of floods and droughts. Many of these weather-related problems are predictable, and so is the recurring “hunger season”—the period before the main harvest is ready—in parts of sub-Saharan Africa. All of these cause a great deal of suffering, including severe malnutrition which threatens the lives of the most vulnerable. In fragile states, vulnerability to shocks is even higher. Each year, humanitarian agencies mobilize relief efforts to save lives. Once the crisis is over, we go back to business as usual.

It shouldn’t be this way. People in the affected communities know all too well that every year the rainy season or monsoon cuts off their contact with nearby towns, or that every year the dry season leaves many families without access to enough food. With the right support, countries and local communities can build systems and develop responses that help people get through these difficult seasons. This way, they are not stuck in the powerless position of hoping, year after year, that emergency assistance will arrive in time.

In 2007 and 2008, many millions of poor people suffered because of a dramatic rise in global food prices, particularly for basic grains such as rice and wheat. They had no control over the causes of the price hikes, and they had very few coping mechanisms. Poor families spend a large percentage of their income on food, so when prices soared, they had to cut back on more nutritious foods, eat fewer meals, and go without other basic needs such as health care. The World Bank estimated that the food price crisis pushed more than 100 million people deeper into poverty.

The crisis served as a wake-up call — it risked reversing the tremendous progress the world had made in reducing extreme poverty and hunger. In fact, according to the U.N. Food and Agriculture Organization (FAO), progress against hunger stalled due to high and volatile food prices.

As a result, there has been a greater focus on the concept of resilience since 2008. It is very important that USAID now has its first policy and program guidance (PDF) on building resilience. Through Feed the Future and Food for Peace, USAID has already acted on important components of such an undertaking, with the focus on reducing malnutrition in the 1,000 days between pregnancy and age 2 and helping smallholder farmers improve their livelihoods and diversify diets in their families and communities. Social safety nets are also essential. With dramatic weather events and food price volatility only likely to continue and intensify due to climate change, the need to build resilience has never been greater.

16 Day Challenge: Invisible Women: Violence Against Women with Disabilities

Today is Day 9 of our 16 Days of Activism Against Gender Violence.

There are over a billion people with disabilities on the planet. Approximately half of them are women with disabilities. They are grandmothers, mothers, partners, lovers and sisters. They are seldom seen in market places, the fields, the classrooms, at the health clinics or in the workplace. Women with disabilities are by and large an invisible group in society. Their invisibility is partly due to the multiple forms of discrimination and the intersectionality of disability and gender.

Violence against women and girls with disabilities is an important, and often overlooked, aspect of gender-based violence. A reflection of attitudes ingrained in all cultural systems of the world where women are seen as lesser human beings – and women with disabilities as even less worthy – makes it easy for abusive power and control over them. Research by Women’s Aid indicates that one in four women experience domestic violence. For women with a disability, this figure doubles. Be it at the hands of their partner, family, or caregiver, almost one in two women with disabilities will be abused in their lifetime.

Two women conducted a street poll on disability issues for a disability inclusiveness project in Armenia. Photo Credit: World Vision

The experiences of women with disabilities fit within traditional definitions of domestic violence, but some do not – they are disability-specific, such as having medicine withheld, being physically assaulted, deliberately not being assisted to go to the toilet, or having their assistive devices taken away.  Also women with disabilities may fear reporting or leaving an abuser because of emotional, financial or physical dependence, or fear of loss of parental rights. In situations of conflict where rape is often used as a weapon of war, women with disabilities are seen as easy targets. Conversely, situations of conflict invariablely increase the incidence of disability. The United States Government National Action Plan on Women, Peace and Security highlights the need to take special measures to protect women and girls with disabilities from gender-based violence, particularly rape and other forms of sexual abuse, and all other forms of violence in situations of armed conflict.

The Convention on the Rights of Persons with Disabilities (CRPD), adopted by the U.N. General Assembly in 2006, recognized that “women and girls with disabilities are often at greater risk, both within and outside the home of violence, injury or abuse, neglect or negligent treatment, maltreatment or exploitation” and emphasized “the need to incorporate a gender perspective in all efforts to promote the full enjoyment of human rights and fundamental freedoms by persons with disabilities.”

So as we work to combat the epidemic of violence against women, the inclusion of women with disabilities must be deliberate.  For examples, shelters must have the necessary accommodations for women with disabilities. Courts should have ramps, sign language rosters and trained staff who do not turn away women with disabilities because they do not think they are deserving of services.

Our intensified efforts to eliminate all forms of violence against women must translate into accessible information on a range measures – that legal frameworks and policies are more reflective of the day-to-day experience of women with disabilities; that  prevention actions are addressing all segments of the population; that efforts to prosecute perpetrators and protect and support victims recognize the specific needs women with disabilities might have;  and that  initiatives to enhance research and collect desegregated data include women with disabilities.

Finally as we consider the major structural factors underlying gender-based violence, it is necessary to address disability-based discrimination as a root cause of some of the gravest inequalities and human rights violations in the world. The intersection between gender and disability needs to be addressed explicitly and recognized in the post-Millennium Development Goals (MDG) framework and beyond.

Putting People at the Heart of Resilience

Since 2000, it is estimated that floods, cyclones, tsunamis, earthquakes and other natural hazards have cost the world more than $1 trillion. These disasters have triggered significant social, ecological and economic devastation well beyond their immediate points of impact. As the President of Oxfam America, a humanitarian relief and development organization, I am often asked which characteristics makes one community more resilient than another and what can communities do to better prepare for natural disasters?

Under Administrator Raj Shah’s leadership, USAID has been trying to answer these questions and today released its first ever policy and program guidance (PDF) on building resilience to recurrent crisis. This guidance should be considered a breakthrough, and Oxfam congratulates USAID on a very thoughtful framework to saving lives and creating conditions where families and communities can prosper. The guidance outlines a real commitment to link short-term humanitarian response interventions with longer-term development programming by creating joint planning cells that work comprehensively to address both humanitarian and development needs in close coordination. This is not an easy undertaking. Oxfam, too, is trying to do a better job at linking humanitarian and development programming in countries where we work.

Medhin Reda in her teff field at her home in Tigray, Ethiopia. Oxfam America and partners are working on the Rural Resilience Initiative, which offers the poorest farmers a chance to buy weather insurance. For those too poor to have cash, they can pay for their premiums by working on community projects. The initiative also promotes a variety of tools that will help rural families build their resilience, including access to credit, encouragement to save, and steps to reduce the risk of disaster. Photo Credit: Oxfam America

For me, what makes some more resilient than others comes down to people’s rights. The question is: rights – who has them, who doesn’t and why? Risks and vulnerabilities are never equitably distributed:  poor men and women are more vulnerable because of the structure of their societies and economies.  Lack of access to economic assets, essential natural resources, or to political power translates into greater risk and vulnerability when crises hit. That is why it is essential that when we talk about resilience, we must also talk about issues of rights and equity and how they contribute to resiliency.  As USAID goes about implementing its new guidance throughout the world, this interrelationship should be at the core of the new framework.

As an example of how resilience, rights and equity relates in El Salvador, located in one of the world’s most vulnerable regions to natural disaster, Oxfam has been part of disaster risk reduction programs in which community organizations have not only led projects to prepare communities to evacuate, but have also taken measures to reduce the chance of floods. Those same groups have helped bring about the enactment of civil protection laws, which has subsequently enhanced government investment, in risk reduction infrastructure for communities where it is needed most.

The new USAID guidance comes at a critical juncture when the world is looking more deeply than ever at how to assist people and their societies withstand and recover from a growing number of natural disasters. In many cases, national governments and the poorest and most marginal communities already have found ways to increase their resilience, and we should be doing more to enhance their capacity to prepare for and respond to crises. We would be remiss to not only support local capacity but to ensure communities’ successful approaches and methods to weather disasters are at the heart of our operational principles.

Does the New Resilience Policy Have Staying Power?

The global “resilience” agenda is exciting – and overdue. The idea that aid should invest not just in responding to crises, but also in preventing, mitigating, and helping people adapt to them, has been around for a long time. Yet for too long, the global aid architecture has been stuck with a basic split between relief and development camps. The relief side responds to the effects of major shocks (droughts, wars, economic calamity, etc.) but has struggled to address why so many people are so vulnerable in the first place. The development side has in turn steered clear of shock-prone populations and focused most of its resources on (relatively) safe and stable populations.

Villages that have received Mercy Corps training and initial seeds to build community gardens are faring much better with a wide variety of produce to feed their families and sell in local markets. Photo Credit: Cassandra Nelson, Mercy Corp

Dating back at least to the early nineties there have been repeated – failed – attempts to move past this divide and find ways to apply developmental tools to chronic humanitarian problems. We have seen some incremental improvements – practices like using cash and vouchers to work within local markets during a humanitarian response – rather than destroying those markets with floods of free imported commodities. But the global aid system at large still retains the relief-development split – in targeting, practices, architecture and funding streams.

So resilience is exciting not because it is a fundamentally new idea – it is not – but because where past efforts to move the global aid architecture past the relief-development divide have failed, the global resilience agenda frames this idea in a way that is compelling – to donors, aid providers, and critically, to the governments and citizens of at-risk countries.

But this exciting agenda remains tenuous, and realizing its potential will be hard work. Resilience transcends many of the basic organizing principles that have long characterized the relief and development worlds; it challenges all of us to make major changes to how we do business. Major reform of entrenched systems, practices and norms is never easy. This new USAID policy on resilience represents a very important starting point for tackling that challenge.

The policy gets some important things right. In Mercy Corps’ experience, interventions that build resilience have to be highly flexible and closely tailored to the specific context that they target. It is good to see USAID affirm that resilience interventions must bring together activities that have traditionally operated in silos – economic development and livelihoods, natural resource management, water and sanitation, health and nutrition, conflict mitigation, governance, risk reduction, and so on. The policy’s focus on joint planning and design of programs across different parts of USAID “turf” is a big step forward, as is the mandate that USAID’s country planning processes must consistently build in a focus on resilience.

Mercy Corps believes it’s vital to invest in ways to stop the cycle of hunger from recurring. Their cash-for-work projects allow people to earn money, buy food locally, and prepare their fields for a better harvest season. These crescent ditches will allow rain water to soak into the land rather than running off and causing flooding and erosion. Photo Credit: Cassandra Nelson, Mercy Corps

At the same time, talking is easier than doing. This policy is a strong step forward but it does not – at least not yet – guarantee a major shift in USAID’s own practices, structures and systems, which still largely reflect the basic relief-development divide. This policy takes an approach of working within the existing USAID architecture, rather than seeking to alter it. This is an easier lift – but will it be enough? The policy notes that leadership within the agency will be critical to pushing through roadblocks and ensuring that entrenched habits evolve. And the current leadership of the agency deserves tremendous credit for having done just that with the responses in the Sahel and the Horn of Africa. But as with any government agency, leadership will eventually change and priorities will change with it. The major test for this policy – as for the global resilience agenda more broadly – will be whether it will have staying power to remain relevant even after the current buzz around resilience subsides.

Book Review: “No Time to Lose: A Life in Pursuit of Deadly Viruses” by Peter Piot; Reviewed by Jennifer Albertini, USAID Africa

Jennifer (Jenny) Albertini is Senior HIV/AIDS Technical Advisor for USAID Africa's Health Team where she focuses on policy, program and technical guidance for the Agency's HIV/AIDS programs in Africa. Jenny has worked with PEPFAR since its inception, including spending seven years in Zambia and Swaziland implementing and managing HIV/AIDS programs there.

Synopsis

For many, childhood is a time of wonder and ambitious dreams to travel to foreign lands and work on issues of social justice.

Often times, such dreams remain unfulfilled – but, not for Peter Piot. As he details in “No Time to Lose: A Life in Pursuit of Deadly Viruses,” more than half of Piot’s life has been spent chasing viruses and politicians around the globe in his effort to understand and mitigate the impact and devastation of infectious diseases.

What started as a mysterious virus delivered to his laboratory in Belgium in 1976 led to his first trip to Africa to pursue what later became known as Ebola. Before he knew it, Piot was partnering with scientists in Africa to investigate other infectious diseases, including sexually transmitted infections, positioning him well for when AIDS began chipping away at the continent in the early 1980’s. He was at the forefront of efforts to unravel what quickly became the newest and fastest growing pandemic. Translating his scientific prowess into bureaucratic-ease, a decade later, Piot helped bring together 10 United Nations agencies to form UNAIDS, the Joint United Nations Programme on HIV/AIDS. UNAIDS was the first UN agency dedicated solely to working on fighting one disease. He led the agency for 14 years (1994-2008).

No Time to Lose…” isn’t just about the laboratories and boardrooms that Piot was able to grace during his career. As he describes, his relationship with truck drivers and heads of state, physicians and patients, and commercial sex workers and advocates is what pushed him to keep fighting, learning, fundraising, and advocating for those affected with infectious diseases for more than thirty years. These relationships still drive him, and this book is as much a reflection of his career in global health as it is an expression of his respect for the people who have been most affected around the world.

Review

Piot’s book is not just a clinical review of infectious diseases – in fact, in the context of his narrative, Ebola or HIV & AIDS could have gone by any other name. What matters – and where Piot devotes much of his prose – is the impact that these diseases have had on the fabric of societies, and how the themes of poverty, family and governance radiate throughout all of their (and our) lives. He was able to connect the science uncovered in the laboratories with the faces of the patients he saw in clinics from Brussels to Kinshasa – and throughout the world. Perhaps most importantly, his book brings these stories to the world leaders he lobbied for so many years to do more to advance efforts to fight HIV & AIDS in their countries. He was not always successful at moving them towards action, but he always tried. And, his persistence is palpable through the pages.

I first saw Peter Piot in a nightclub in Rio during the International AIDS Society conference of 2005. As a self-proclaimed “public health nerd,” it was practically a celebrity sighting to see such an esteemed man dancing with the rest of us mere mortals. The results of a successful male circumcision trial in South Africa had been released that day and there was buzz in the air about this highly efficacious prevention intervention. It felt good to take a deep breath and celebrate a win for once.

One of my favorite quotes from Piot, as he describes AIDS, is, “This time, I knew, we were looking at the worst epidemic I could imagine, the greatest assailant I would ever face, something that would absorb all the energy that I could throw at it, and far more. In my mother tongue, Dutch, I wrote in my notebook:  Incredible. A catastrophe for Africa. This is what I want to work on. It will change everything.”

A lot of progress has been made since that catastrophe first started 30 years ago. We are now – hopefully – on a path towards creating an AIDS-free generation. As we commemorate World AIDS Day this year, a review of Piot’s book seems most timely. It allows us to reflect on where we have been and how far we have come, but it also serves as an impetus to keep moving towards our goal with a sense that there is ‘no time to lose.’

Discussion Questions

  1. Although Piot lobbied South African President Mbeki repeatedly to change his way of addressing HIV/AIDS in his country, years went by before real change happened as the epidemic grew worse. Was there anything Piot could have done differently to have moved Mbeki into action earlier?
  2. Certain African leaders (like Festus Mogae of Botswana) have been outspoken champions on HIV/AIDS. What are the characteristics or drivers which have made them positive leaders and what would it take for more of their peers to also take on these efforts?
  3. Did the creation of UNAIDS serve (one of) its intended purpose of focusing UN efforts around a single disease to achieve maximum impact, or would they have made more of an impact utilizing their existing platforms?
  4. Several recent articles have focused on balancing career and family, like Anne-Marie Slaughter’s piece “Why Women Still Can’t Have It all.” Piot mentions his family rarely in this book, although the birth of his children coincided with the beginning of the initial Ebola and AIDS outbreaks and he speaks volumes about his incessant travelling, late nights at work, etc. What are the differences that would have been experienced by a woman taking on Piot’s role at the time he worked on these issues?  What, if anything, would be different now?

Book Review: “Tinderbox” by Daniel Halperin & Craig Timberg; Reviewed by Roxana Rogers, Paul Mahanna, David Stanton, Office of HIV/AIDS

Roxana Rogers, Director of the Office of HIV/AIDS, has a lifetime of experience working for USAID, previously supporting health offices in Zimbabwe and Burkina Faso. She has also worked as the Health & PEPFAR Office Chief at the USAID mission in South Africa.

Synopsis

Daniel Halperin, a medical anthropologist with a peripatetic background, including work with USAID, and Craig Timberg, a Washington Post journalist, combined impressive talent in this book, which details the unintended consequences of colonialization as it created the ideal situation for an explosive AIDS epidemic.

For centuries, or even millennia, SIV (simian immunodeficiency virus) had been carried by monkeys, and probably jumped from monkey to man many times as men killed and cut up monkeys to eat as bush meat. But, until the time of colonial ransacking, the virus fell on wet moss, infecting households occasionally but travelling no further. The brutal intrusion of colonial Europeans seeking fast wealth and power destroyed ancient social norms, tore apart families and created a “tinderbox” ignited by the spark that turned into a raging epidemic.

The authors provocatively argue that Westerners, and even USAID, have failed to appreciate the unique risk factors in this tinderbox. HIV spreads in very different ways in different parts of the world, yet we used (and still tend to use) the same approach to fighting the epidemic everywhere. While acknowledging the importance of treatment and other interventions, the book argues that in Africa the major intervention for HIV should be prevention aimed directly at the main cause of its spread: sexual behavior. They also argue that local solutions work best.

Review

We found this a fascinating, very readable book that draws on science, social history, anthropology and personal stories to tell the evolution of the disease and recommend solutions.

The book traces HIV’s spread over the last century, starting from chimpanzees in isolated West African rainforests to the boomtown, Leopoldville, and from there to the rest of Africa and the world. It tells the unlikely story of how an American Rhodes scholar who had bicycled across Africa, paired up with a venerable evolutionary British biologist and traced the genetic history of the virus by analyzing samples of blood and tissues that had remarkably been preserved for 40 or 50 years. And, how Californian scientists studied monkey feces in remote sections of Cameroon to determine the exact area where the virus leaped from monkey to man.

It tells compelling stories about Africans infected early, before drugs were available, struggling to warn people to change behavior despite the stigma associated with AIDS; people like the famous Zairian singer Franco, who died in 1989; and, the popular Ugandan singer Philly Lutaaya who spent his last days singing messages of prevention and hope. And, how President Museveni in the earlier days of his presidency, recognized the threat posed by HIV and preached “zero grazing.”  Under the influence of this early leadership, behavior changed dramatically in Uganda and prevalence fell rapidly.

The authors also take aim with certain aspects of the U.S. Government’s President’s Emergency Plan for AIDS Relief (PEPFAR), which they say has taken an approach to fighting HIV that is expensive, not adapted or locally designed, and too dependent on technology. In its initial days, they say PEPFAR was too focused on A, for ‘abstinence’ when the focus should have been on B, for ‘be faithful’ – also known as partner reduction. They point out that condoms have a role to play where key populations – such as gay populations and sex workers – drive the epidemic, but not where the epidemic is generalized and affects all populations indiscriminately. USAID promoted condoms as one key strategy to fighting AIDS because they played a significant role in driving down the epidemic in the U.S., and because they were easy to count and report as indicators, claim the authors. Dr. Halperin, who was an outspoken advocate of circumcision to prevent HIV long before the World Health Organization (WHO) had endorsed it based on the outcome of three clinical trials, laments that had we promoted circumcision years earlier, much transmission would have been prevented.

Today, the United States is looking to eliminate AIDS as a disease of consequence. The tipping point, when the infection rate falls below the rate of new people on treatment, is in sight. In November, one year ago, Secretary of State Hillary Clinton announced that the U.S. Government is on the road to an AIDS-Free generation; then on World AIDS Day last year, President Obama announced that the United States, through PEFPAR, would scale up treatment, circumcision and prevention of mother to child transmission interventions, with the dual goal of saving lives and preventing new infections.

The contributions of the United States to fighting HIV & AIDS and improving health in Africa have been outstanding. Indeed, it is now hard to remember what Southern and Eastern Africa looked in 2003. AIDS affected every aspect of life. Hospitals were overwhelmed. I remember visiting a hospital where two people shared the same bed and a third laid on the floor. Coffin-making was a growing business and funerals were almost a daily event. This has turned around dramatically, with much credit to PEPFAR and USAID. Almost 8 million in the world are receiving treatment, and more than half of those receive some support from PEPFAR.

Indeed through PEPFAR, USAID has changed the world. Some coffin makers are going out of business. Yet, it would be a mistake to ignore the lessons from this book. We know that sustaining the response will be challenging over the long term. The findings of many studies confirm what we already know — that adherence is a challenge. Risk perception is low. Uganda, the early success story, is now experiencing an increase in prevalence as the commitment of local leadership has waned. Unless there is fundamental behavior change that accompanies the scaled up efforts around treatment, our remarkable success to date may be short lived.

Discussion Questions

  1. The authors present some unorthodox views on the long-term approaches to ending the AIDS epidemic. To what extent do you agree or disagree with their case for “how the world can finally overcome AIDS”?
  2. A number of countries are now experiencing declines in HIV prevalence. What, if any, are the roles of interventions that address changes in behavior as other more aggressive interventions, such as treatment for prevention and circumcision, are rapidly being scaled up in Africa?
  3. The AIDS epidemic in Africa is a tragic example of the negative consequences of both colonialization of Africa and the increased mobility and inequity that accompanied economic development. But, was it inevitable?  What are the lessons learned from the history of HIV in Africa and around the world?
  4. The book outlines the importance of local leadership in affecting social change. If this is true, what is the role of an international development agency in affecting sustainable long-term change?
  5. What most surprised you in the book?  Has your view of the HIV epidemic changed after reading this book and how?

Implementation Science in Action: Turning HIV Research Into an AIDS-free Reality

I began work in USAID’s Office of HIV/AIDS this past August – and, what an exciting time it’s been! With the agency-wide shift towards program efficiency, capacity building, country ownership and sustainability, a new term has risen to prominence: implementation science.

The implementation science framework aims to increase the sustainability, cost-effectiveness and impact of global health programs in areas hardest hit by HIV & AIDS. It translates and implements research findings into routine and common practice. As we come together this week to commemorate World AIDS Day 2012, it’s important to remember the vital role and impact implementation science has in helping us achieve an AIDS-free generation.

In August 2011, USAID announced the Annual Program Statement (APS), “Implementation Science Research to Support Programs under PEPFAR.” Under the first round of the APS, USAID and PEPFAR awarded more than $21 million for eight studies in eight countries. I’ve had the privilege to provide support to each of these eight studies. While implementation has only just begun, I am confident that the impact of these studies will be powerful.

These eight studies will answer critical questions such as:

  • How can we shorten the time between an HIV positive diagnosis and entry into care?
  • What are the most cost effective and feasible measures to significantly reduce MTCT?
  • How do we translate the high efficacy of antiretroviral-based prevention found in clinical trials to programmatic delivery?

Hopefully, by now, you are as excited about implementation science as I am, because this is your chance to channel your excitement into action! The second round of the APS “Implementation Science Research to Support Programs under PEPFAR” is underway. The APS solicitation is public and the deadline for concept paper submissions is January 31, 2013.  USAID anticipates awarding up to 10 awards, with maximum funding available for a single application set at $1.8 million over three years.

The scope of the APS provides a unique opportunity to fund cutting-edge research in HIV-specific program areas, improving the integration of programs across the prevention, care and treatment continuum.  Data gathered will support efforts to prevent new infections and save lives.

Have a great idea? Apply! Know a local organization with research capacity expertise? Share the solicitation!  I’m excited for the innovative ideas that will be evaluated in Round 2!

Young People in Bosnia Drive Economic and Social Development

The release of the new USAID policy (PDF) on youth and development is an opportunity to reflect on whether our work in development is truly serving the next generation.  As millions of young people transition from school to work, the urgency of the problem is clear. These young people have the potential to be engines of significant economic growth and agents of social change.  But if we fail to equip them with the skills they need, and if the market is unable to provide meaningful work, they will be a drain on national resources and a source of social instability.

Here in Bosnia and Herzegovina, the problems faced by youth are particularly severe.  Unemployment among young people between the ages of 15 and 24 ranges as high as 60 percent.  And young people in Bosnia and Herzegovina are suffering a crisis of confidence.  They have lost faith that this society can provide them any opportunity for success. Civic involvement among young people is extremely low, and an alarming 97 percent of youth believe they have no or little influence on important decisions in the local community.

But the problem does not lie in them.  The problem is a society where young people have been taught that corruption is normal and acceptable, that the powerful can prey on the weak with impunity, and that the citizen does not have a meaningful voice.

A young woman from Zvornik in north-east Bosnia-Herzegovina is using a blower door and meter to measure air leakages to determine weatherization strategies in a rural house for the upcoming winter.

Yet these young people are brimming with good ideas to challenge societal norms. With the help of USAID, young people around the country are developing projects and putting them in motion. These projects are designed to tackle many of the country’s greatest needs.  These young people want to be the driving force behind social change by rebuilding divided multi-ethnic communities, becoming political leaders, and working with local officials to push for changes and resources for youth-driven community projects. They are ready to move their country into a prosperous future as a member of the European Union.

Investing in these young people is one of the soundest investments we can make. Development programs targeting youth can be enormously cost effective.  USAID Bosnia is investing in programming that leverages three dollars for every dollar of USAID assistance.  We are investing in job training programs linked to strategic industries in partnership with the private sector.  And we are teaching young people how to advocate for themselves.  By strengthening civil society, promoting entrepreneurship and helping to develop young leaders, we believe that a small investment now will result in a significant return in both economic and social development.

For more about youth programs in Bosnia and Herzegovina, visit our website.

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