Health

  • UNDP reportThe United Nations Development Programme (UNDP)’s 2014 Human Development Report, entitled Sustaining Human Progress: Reducing Vulnerabilities and Building Resilience, calls attention to the persistent vulnerability that threatens human development. According to the recently released report, 2.2 billion people are poor or near-poor, and unless policies and social norms systematically address their vulnerabilities, development will fail to be equitable or sustainable.

    The report proposes multiple ways to strengthen resilience, such as the provision of basic social services and stronger policies for social protection and full employment.

    “By addressing vulnerabilities, all people may share in development progress, and human development will become increasingly equitable and sustainable,” said UNDP Administrator Helen Clark. Read the report.

  • Research on key populations leads Botswana to smarter HIV prevention

    At approximately 18 percent, the prevalence of HIV in Botswana’s general population is one of the highest in the world. As a result, national HIV prevention efforts have focused more intensively on the general population than on other populations. Little is known about key populations, such as female sex workers and men who have sex with men, whose behaviors are both stigmatized and illegal in Botswana.

    In 2012, the Botswana Ministry of Health used an integrated behavioral and biological surveillance survey to estimate population sizes and prevalence of HIV and sexually transmitted infections (STIs) among female sex workers and men who have sex with men. The study was historic. For the first time, it showed the HIV and STI burden among these two key populations and raised awareness about how they might have contributed to the generalized HIV epidemic.

    The survey, carried out with technical assistance from FHI 360 through the Preventive Technologies Agreement (funded by the U.S. Agency for International Development), uncovered a population of more than 4,000 female sex workers in the three districts where the survey was conducted. Among these female sex workers, HIV prevalence was 61.9 percent, and the prevalence of gonorrhea and chlamydia were both higher than 10 percent. The female sex workers had a mean of more than seven partners per week, and condom failure, which includes condom breakage and being paid or forced not to use condoms, was common.

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  • Improving HIV testing in targeted populations in India

    At the 20th International AIDS Conference (AIDS 2014) in Melbourne, Australia, staff from FHI 360’s India office will present a poster on a study that shows improved HIV testing among clients of female sex workers. The study contributes to evidence about what works to strengthen HIV prevention.

    Why focus research on the clients of female sex workers?

    Recent studies from India suggest that the purchase of sex from female sex workers is most predominant in higher HIV-prevalence states, such as Andhra Pradesh, Maharashtra and Tamil Nadu. In India, there is a growing recognition of the importance of considering clients when looking to stop HIV transmission, and a number of prevention efforts under the national program have targeted these clients, most of whom are men.

    Conducting surveys among clients of sex workers is challenging, because clients do not like to be identified. There is also little evidence that establishes clients’ risk of contracting HIV in India. To bridge this gap and to provide invaluable information on HIV trends and risk behavior, FHI 360 designed and managed the largest integrated biological and behavioral assessment (IBBA) for most-at-risk populations in India.

    Collecting evidence to inform HIV programming

    Conducted in 2006 and 2009, this cross-sectional survey interviewed approximately 10,000 clients of sex workers as part of Avahan (the India AIDS initiative). This program, funded by the Bill & Melinda Gates Foundation, gathered evidence to inform future HIV prevention programs in India. The IBBA survey was implemented by the institutes of the Indian Council of Medical Research, and technical support was provided by FHI 360.

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  • Focusing on key populations affected by HIV: A smart investment for greater impact

    In an era of limited resources, HIV prevention, care and treatment efforts need to focus on the smartest investments. This means investing in programs that can have the greatest impact in halting HIV transmission and turning back the epidemic. From a public health perspective, the effective use of resources requires focusing on key populations who have the highest level of HIV infection and tackling the barriers that discourage and prevent them from accessing health systems and services. These populations are broadly defined as sex workers, men who have sex with men, transgender persons and persons who inject drugs.

    As the world gathers at the 20th International AIDS Conference (AIDS 2014) in Melbourne, Australia, July 20–25, 2014, we have an excellent opportunity to share how investing in evidence-based strategies can change the trajectory of the epidemic once and for all.

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  • The role of youth sexual and reproductive health in individual and national development

    In honor of this year’s World Population Day, the theme of which is youth engagement and the sustainable development agenda, we are reflecting on youth — our future leaders, parents, entrepreneurs and citizens. Today’s generation of young people is the largest in history: there are 1.8 billion people between the ages of 10 and 24 on the planet. In many countries, more than half of the population is under age 25, creating opportunities for national economic growth but also underscoring the need for greater investment in their health — with consequences that will affect the world’s social, environmental and economic well-being for generations.

    Investment in young people’s sexual and reproductive health in particular ensures that young people are not only protected from HIV and other STIs, but also that they have the number of children they desire, when and if they wish to have them. The ability to control one’s fertility increases individuals’ productive capacity and can lead to a decline in a country’s dependency ratio (number of working citizens compared to nonworking citizens). When the dependency ratio declines in conjunction with adequate investments in youth education and economic opportunity, per capita income can increase — a phenomenon known as the demographic dividend.

    Unfortunately, many young people do not have access to the critical sexual and reproductive health information and services required to stay healthy and avoid unintended pregnancy. Many young women report not wanting to become pregnant, but the level of unmet need for contraception among adolescents is more than twice that of adults. In some regions of the world, the unmet need for contraception among adolescents is as high as 68 percent. Fulfilling the unmet need for contraceptives among adolescents alone could prevent an estimated 7.4 million unintended pregnancies annually.

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  • A bold plan for ending HIV and AIDS in New York State

    Dr. Timothy MastroFor more than thirty years, health care providers, program implementers, policymakers and academic researchers have strived to meet a goal that once seemed impossible: a world without AIDS.

    The fourth decade has brought hope, based on extraordinary progress in learning how to combine HIV treatment and prevention. However, much work remains to be done, including in the United States where, according to the U.S. Centers for Disease Control and Prevention, the groups most seriously affected are gay, bisexual and other men who have sex with men, and, in particular, young African-American men who have sex with men.

    On June 29, 2014, Governor Andrew Cuomo of New York announced an initiative designed to achieve an AIDS-free generation in his state by 2020. Governor Cuomo’s three-pronged plan focuses on improved testing, preventing the spread of the virus and providing better treatment for those living with HIV.

    At FHI 360, we applaud Governor Cuomo’s bold plan to end the HIV epidemic in New York State. We currently have the scientifically proven prevention and treatment tools to stop HIV transmission. Now, we need to commit to using these tools for all populations in order to end the epidemic in New York, the United States and globally.

    We are encouraged to see Governor Cuomo take a brave stand against HIV and hope that others will join him. Together, we believe we can make a world without AIDS a reality.

  • Don’t forget about dad: Six strategies for getting fathers more involved in child feeding

    Whether he’s aware of his influence or not, almost every father in every culture influences his family’s choices about how to feed the children. His everyday decisions about how many of the eggs the family’s chickens lay will be sold at market and how many will be kept at home for the family to eat can make the difference between a stunted child and one who reaches his or her full growth potential.

    The Alive & Thrive project reviewed programs from around the world that were designed to engage fathers in child feeding, identifying the strategies that seem to make these programs work. Not surprisingly, the six strategies we identified in the most innovative “dads” programs echo sound principles from behavior change and social marketing. Our review indicated that, especially when program planners apply these six strategies, fathers’ actions can lead to real improvements in nutrition.

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  • Bringing global attention to the need for reducing micronutrient malnutrition

    Good nutrition is critical in preventing child and maternal deaths. Deficiencies in micronutrients, such as iodine, iron, vitamin A and zinc, can lead to impaired physical and cognitive development, poor pregnancy outcomes (for example, a low birth weight baby), a weakened immune system, anemia, night blindness and even death. It is estimated that micronutrient malnutrition affects more than 2 billion people worldwide.

    For more than a decade, the Food and Nutritional Technical Assistance (FANTA) project, funded by USAID, has been a key contributor to the global effort to reduce micronutrient deficiencies. Our work has focused on the development of new methods to identify dietary gaps, through research on the impact of lipid-based nutrient supplements on the health status of vulnerable populations and dissemination of the most up-to-date, relevant information to a wide range of nutrition stakeholders.

    Recently, FANTA contributed to the development of software called Optifood, which can be used to identify local food combinations that can fill (or come as close as possible to filling) micronutrient gaps based on local foods and diet. Optifood results contribute to the development of cost-effective, context-specific approaches.

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  • Midwives: An essential resource for ensuring safer deliveries

    Worldwide, we have seen maternal deaths decline in recent years. In no small part, this is due to an underappreciated commitment by a highly valued global human resource: midwives. As the 30th Triennial International Confederation of Midwives (ICM) Congress begins in Prague, we must recognize that midwives provide a critical entry point for pregnant women and their newborns to receive life-saving health care services that are respectful and women-centered.

    A range of services is necessary to protect and enhance women’s health and well-being before, during and after a pregnancy. Most maternal deaths are caused by the underlying health conditions of the mother before or during pregnancy, or by poor quality care in the critical hours and days before and after a birth.

    Four key services comprise the continuum of care during pregnancy:

    1. Antenatal care with a skilled provider, ideally to include several visits beginning in the first trimester
    2. Delivery with a skilled attendant, including the routine monitoring of the progression of the delivery and the availability of drugs, such as oxytocin, for the prevention of postpartum hemorrhage
    3. Immediate emergency care for medical complications that arise during pregnancy and childbirth
    4. Postpartum and postnatal care for the mother and baby shortly after birth to ensure both are healthy and that the baby receives essential newborn care while the mother receives family planning counseling

    Midwives throughout the world are capable of providing a range, if not all, of these services. But their role is more crucial in health care systems in low- and middle-income countries. In some regions, midwives are already making a dramatic difference by providing pregnancy and delivery services in low-resource settings. We need to ensure that regions without such midwifery-led services receive equal access.

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  • Why adolescents?

    In 2012, young people ages 15 to 24 accounted for an estimated 40 percent of new nonpediatric HIV infections worldwide [UNAIDS World AIDS Day Report 2012]. Furthermore, perinatal HIV transmission is a major cause for HIV infection, and given the success of pediatric antiretroviral therapy (ART), many more infants born with HIV are growing up into adolescents and young adults living with HIV.

    While care and treatment programs for people living with HIV (PLHIV) can be found in every country, there is a gap in provision of ongoing, supportive counseling for adolescents living with HIV (ALHIV). Adolescence is often when young people begin having sex, which increases chances that adolescents living with HIV might pass the infection to partners who are HIV negative. Another concern is that girls living with HIV may become pregnant; if they do not know about or have access to services for preventing mother-to-child transmission, they can pass the infection to their babies. Given that adolescents are a large sub-group of those living with HIV, there is a need for tailored interventions and support systems that address adolescents’ unique vulnerabilities.

    Positive Connections

    To shed light on the specific health and social support needs of ALHIV, FHI 360 — on behalf of USAID’s Interagency Youth Working Group — developed a resource called Positive Connections: Leading Information and Support Groups for Adolescents Living with HIV. This unique guide provides facilitators with background information about the needs of ALHIV, tips for starting an adult-led information and support group, 14 sessions to follow in a group setting and guidance on tracking a program’s progress.

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