Big breakthroughs in HIV science, such as antiretroviral therapy and the “universal test and treat” policy, create hope and galvanize efforts to bring the epidemic to an end. Yet, no matter how promising the strategy, we know from experience that it is not easy to incorporate the latest approaches into poorly resourced, over-stretched health systems. Nor is it reasonable to expect that health systems can absorb the increased volume of patients that seems to go hand in hand with innovations.
Every year, the International AIDS Society (IAS) holds the largest open scientific conference on HIV and AIDS-related issues. This year’s conference, IAS 2017, will take place in July in Paris. FHI 360 is a media partner with IAS 2017, and in the lead-up to this year’s conference, we are coordinating Facebook Live conversations with experts who will be speaking there.
One U.S. expert who will present at the conference is Dr. Anthony Fauci, Director of the U.S. National Institute of Allergy and Infectious Diseases. Dr. Fauci was recently in Washington, DC, to speak at the annual meeting of the HIV Prevention Trials Network. After his plenary talk, Dr. Fauci sat down with FHI 360’s Dr. Otto Chabikuli, Director of Global Health, Population and Nutrition, for a Facebook Live chat on the science of HIV. Dr. Fauci talked about his experience working in HIV research for more than 35 years, addressing issues such as what a cure for HIV might look like, the multiple ways to prevent HIV infection, treatment as prevention, and the projects that his team is currently working on.
An Interview with
Mary Mittochi, Project Director, DREAMS: Malawi Communities Investing in Education for Child Health and Safety, FHI 360
In this Q&A, Mary Mittochi, the project director for DREAMS: Malawi Communities Investing in Education for Child Health and Safety, discusses how this new project will reduce the acquisition of HIV by adolescent girls and boys. The U.S. President’s Emergency Plan for AIDS Relief (PEPFAR) named FHI 360 as one of the winners of the DREAMS Innovation Challenge. The DREAMS partnership, led by PEPFAR with support from the Bill & Melinda Gates Foundation, Girl Effect, Johnson & Johnson, Gilead Sciences and ViiV Healthcare, is helping adolescent girls and young women become Determined, Resilient, Empowered, AIDS-free, Mentored and Safe.
As one of the 56 DREAMS Innovation Challenge winners, how will FHI 360 help adolescent girls and young women become Determined, Resilient, Empowered, AIDS-free, Mentored and Safe?
FHI 360’s DREAMS: Malawi Communities Investing in Education for Child Health and Safety project will focus on integrated, community-led efforts designed to ensure that education, health and economic drivers for staying in school and completing secondary education are simultaneously addressed and strengthened. Over time, this will reduce the incidence of HIV in adolescent girls and boys. By keeping girls in school and connecting them to a comprehensive range of services and supports, we aim to equip them and their communities with the knowledge and agency they need to make more informed choices about their health and their future.
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.
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.
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.
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.
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.