Health

  • Exploring the potential link between hormonal contraceptive use and HIV acquisition

    morrison_charles_2012_220x200Are women who take hormonal contraceptives at an increased risk of acquiring HIV? If so, do some contraceptives put women at higher risk than others?

    This week, the influential health journal, PLOS Medicine, published the results of a large individual-participant data meta-analysis, authored by FHI 360 and collaborators, that seeks to answer these questions.

    While this issue matters to the field of reproductive health, it is especially critical to women in East and Southern Africa. In these regions, women potentially have a double risk factor: high rates of HIV and high use of hormonal contraception, particularly depot-medroxyprogesterone acetate (DMPA), a type of contraceptive that is injected every three months. So far, the evidence on DMPA shows that it is the hormonal contraceptive that has the most potential to increase HIV acquisition; however, the evidence is inconclusive.

    FHI 360’s meta-analysis combines the results of 18 prospective studies, including more than 37,000 women, of whom more than 1,800 became infected with HIV. We found that women who used DMPA had a 50 percent increased risk of HIV acquisition compared with women who did not use hormonal contraceptives. We found no significant increase in HIV risk among women using combined oral contraceptives (COCs) or norethisterone enanthate (Net-En), a contraceptive injected every two months. Women using DMPA also had an increased HIV risk when compared directly with COC or Net-En users.

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  • A warm welcome in Mumbai

    It was 100 degrees outside when we pulled up in front a school in Mumbai last month. We were greeted by the sounds of booming drums, singing voices and ringing tambourines. The children were assembled outside of the school to welcome us. Before arriving, I was curious about how these children would receive us, but all doubts slipped away as they met us with open arms. The memory of that welcome continues to humble and inspire me in my travels to similar schools around the globe. Fifty students from two Mumbai schools were selected to participate in the three-year Johnson & Johnson Bridge to Employment (BTE) program designed to provide academic support, encourage lifelong learning and build awareness of careers in health care. BTE also works with parents, teachers and employees to support and guide students to new opportunities.

    According to 2012 data, only 58 percent of students from municipal areas graduate, leaving 42 out of every 100 young people without a high school diploma. For more than 20 years, BTE has been focusing on impacting communities all around the world with similar statistics.

    We’ve trained over 20 Johnson & Johnson employees, who serve as volunteers to mentor these 50 children, ages 13–16. BTE volunteers here in India and in all programs around the globe talk to their mentees about life and what it took to reach their own career goals and why civic engagement matters. Mentors teach students time management as well as resume writing, interviewing, teamwork and communication skills.

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  • Can women living with HIV and taking antiretroviral therapy use hormonal contraceptive methods?

    Extraordinary gains have been made in the last decade toward increasing access to antiretroviral therapy (ART) for HIV. With an eye toward ending the AIDS epidemic by 2030, UNAIDS recently released bold targets related to HIV diagnosis and treatment. By the year 2020, their aim is to have 90 percent of all people living with HIV aware of their status, 90 percent of people diagnosed with HIV receiving sustained ART and 90 percent of people on ART achieving viral suppression. As we move closer to these laudable public health goals, we must also consider how expansion of ART may affect and be affected by other health issues, such as prevention of unintended pregnancy among women living with HIV.

    An increasingly important issue is whether certain ART regimens are expected to have drug interactions when used with certain hormonal contraceptive methods. In theory, an interaction could affect the efficacy of either medication or cause side effects or toxicity. If contraceptive efficacy decreases, the chances of contraceptive failure, unintended pregnancy and the accompanying consequences increase. A decrease in ART efficacy could lead to treatment failure, viral resistance and greater likelihood of subsequent HIV transmission. Increases in side effects or toxicity can affect quality of life and medication adherence. Yet, despite the importance of this issue, relatively few studies (particularly those with clinical outcomes such as ovulation, pregnancy or treatment failure) have been conducted.

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  • Learning from failure in global development

    One of the most promising trends in global development is the rising priority of understanding and investing in “what works.” As the funds available for international assistance have flatlined in post-recession years, everyone from donors to practitioners has become increasingly committed to making decisions that are informed by evidence. Given FHI 360’s commitment to research utilization, we’re encouraged by the attention being paid to evidence-informed development. Yet, the best-kept secret within the growing what works movement is the importance of learning not just from our successes, but also from our failures.

    Based on typical nongovernmental annual reports, scientific conferences and even social media content, one can be forgiven for forming the impression that our development efforts are nearly perfect. Successes are proudly packaged in glossy formats and heavily disseminated, whereas any objectives not achieved are relegated to the obligatory and typically short lessons learned section. Yet, this practice does not accurately represent an important reality: Development efforts do in fact fail.

    Venture capitalists and corporate investors understand that less than 20 percent of new businesses will succeed, and they invest in innovations and new ideas with a transparent acknowledgment of the high risk for failure.

    So why, by comparison, is the global development enterprise so different?

    Read the remainder of the blog here.

  • Inextricable links: HIV and human rights

    The AIDS epidemic has been characterized by the stigma and discrimination of people who are all too often already on the margins of society.

    This marginalization has made it more difficult for millions of people on every continent to access much-needed HIV prevention, treatment, care and support services. As we recognize International Human Rights Day on Dec. 10, we cannot lose sight of the inextricable link between HIV and human rights, which should be the cornerstone of our response to and understanding of this epidemic.

    And there is, perhaps, reason for cautious optimism. Despite some policy gains and increased global attention, HIV continues to disproportionately affect “key populations” — men who have sex with men, sex workers, people who inject drugs and transgender people. UNAIDS estimates that 40 to 50 percent of new adult HIV infections worldwide occur among key populations and their partners.

    Read the remainder of the blog here.

  • Bringing heart and mind to the fight against HIV

    The rapid spread of the Ebola virus through human-to-human contact — compelled by the urge to embrace a family member with symptoms of infection, to transport a neighbor to the nearest clinic, to nurse the infected or bury the dead despite the lack of basic protective gear — reminds us of the complex relationship between health and human behavior.

    Like Ebola, HIV was once an emergent infectious disease. Although HIV may take years rather than days to kill its victims, similarities exist between HIV and Ebola in the conditions that facilitate their spread and the challenges to containing both diseases. Highly stigmatized, those who fear infection may avoid being tested or disclosing to loved ones; those diagnosed may face limited treatment options provided by harried health care workers within overburdened health care systems.

    Now in its fourth decade, the fight against HIV has seen tremendous breakthroughs in medical technology. A spectrum of antiretroviral (ARV) treatment options now exists and is available around the globe. Clinical studies have proven that taking a daily oral ARV-based pill can reduce a healthy person’s chance of getting the infection — and, other types of ARV prevention products (i.e., gels, rings and injections) are on the horizon. Increased testing through provider-initiated strategies has increased access to both treatment and prevention technologies. There is even some thought that we will have a cure for HIV one day.

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  • Fast Track: Ending the AIDS Epidemic by 2030

    To mark World AIDS Day, the Joint United Nations Programme on HIV/AIDS (UNAIDS) recently launched its annual report on the state of HIV/AIDS globally. This year’s report, Fast Track: Ending the AIDS Epidemic by 2030, presents new targets to avert 28 million new HIV infections and end the AIDS epidemic as a global threat by 2030.

    The new UNAIDS “fast-track” approach emphasizes the need to focus on the counties, cities and communities most affected by HIV and recommends that resources be concentrated on the areas with the greatest impact.

    The report also contains the latest data on the state of the epidemic globally.

    More details about the report are available, including a press release, a fact sheet, infographics and social media messaging.

    Follow #FastTrack and @UNAIDS to join the conversation.

  • SWOP2014The United Nations Population Fund (UNFPA) recently launched the 2014 State of World Population report, which focuses on the vital role of adolescents and youth in the economic and social progress of developing countries. The Power of 1.8 Billion: Adolescents, Youth and the Transformation of the Future makes the point that young people matter.

    According to the report, nine in 10 of the world’s 1.8 billion young people live in less developed countries, where the young encounter obstacles to education, health and a life free from violence. Without intervention, many of these young people may never realize their full potential.

    Follow #SWOP2014 to join in the conversation.

    Learn more about The State of World Population 2014.

  • How has DAZT’s partnership with the private sector led to better health outcomes in maternal and child health?

    In India, it is important to reach patients through the private sector. At the onset of the project, we conducted a survey that showed that only approximately 67 percent of the people afflicted with diarrhea sought medical treatment, and of this population, more than 80 percent went to a private practitioner. Moreover, in rural and impoverished areas there is a lack of formal medical facilities for those seeking care and treatment for diseases such as diarrhea.

    We are trying to ensure that rural populations receive the best treatment for diarrhea. In order to do that, we must reach the private, rural medical providers (RMPs) who are providing the majority of patient care, especially at the bottom of the economic pyramid. RMPs are not formal doctors, but follow doctors’ patterns for prescribing medicine. They frequently do not have up-to-date information on the most effective ways to treat diarrhea in children. They often prescribe only antibiotics and antidiarrheals, which can be harmful.

    To change this, we started by encouraging formal doctors to prescribe zinc and ORS. We then worked with RMPs to change their prescribing behavior.

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  • Multiple pathways to women’s economic empowerment

    Andrea BertoneAt FHI 360, we take a 360-degree perspective to addressing the most complex human development needs. We envision many pathways to girls’ and women’s economic empowerment — through education; training; access to resources; and the elimination of social, political and gender-related barriers.

    To increase equality between girls, boys, women and men, we believe that a gender perspective has to be integrated into every aspect of all development programs.

    FHI 360 supports women and girls living in poverty, through cutting-edge interventions in health, nutrition, education and economic development interventions. Not only are we implementing some of the U.S. Agency for International Development’s (USAID’s) flagship projects on HIV care, prevention and support — we are also working with multiple donors implementing girls’ education projects as a pathway out of poverty.

    We are addressing women’s poverty in value chains, small and medium businesses, and micro-lending and savings and loan activities. Equally important, we work to engage men and boys as partners and agents of positive social change.

    Why prioritize attention on women and girls? For FHI 360, it comes down to three simple reasons:

    • It is the right thing to do.
    • It improves project outcomes.
    • FHI 360 has strong political will to do so at all levels of the organization.

    We aim to impact in the short, medium and long term the lives of women and girls in many countries. We want to improve women’s and girls’ current access to resources, their economic empowerment, their levels of education and their resiliency in the face of hardship.

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