Tagged: AIDS

  • Gender, economics, and ART adherence: What’s the connection?

    In a rural village in central Africa, my colleagues and I stood over a registration book for antenatal care clients with the goal of identifying clinic-level data that could be extracted for a project evaluation. As we made our way through the book, the left sides of the pages were filled with names of women, dates and HIV test results — it was clear that almost all of the women who tested HIV positive received some form of antiretroviral therapy (ART). As my eyes ran to the right across spaces for follow-up records, however, the fields became increasingly emptier, and our team began to discuss the various barriers to services, even a highly effective service like prevention of mother-to-child transmission (PMTCT).

    Access and adherence to the greater continuum of HIV care is influenced by several factors, including community-level gender norms and related behaviors. For example, HIV-positive men may avoid HIV testing and may spend a significant amount of their income attempting to address symptoms of their illness rather than confirming their HIV status. Often, these behaviors are driven by fear that knowledge of a positive HIV test result could compromise their leadership at home and cause family instability. Research has also identified instances when men undermine their wives’ access and adherence to ART, even taking their wives’ medication for themselves. Interestingly, despite such challenges, women are more likely to access and adhere to HIV-related treatment and care than men.

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  • AVAC, a global advocacy organization for HIV prevention, recently released AVAC Report 2013: Research and Reality. The report urges the biomedical HIV prevention field to address gaps between the promising data from recent clinical trials and the complicated reality of implementing new options. The need for a renewed focus on the research agenda for women’s HIV prevention is also emphasized.

    The report calls on funders and researchers to learn from the lessons offered by recent HIV prevention trials with better problem solving, more critical thinking and coordinated action around large-scale human trials; faster rollout of proven options; and ongoing research for new advances in HIV prevention methods that women and men will want to use.

    FHI 360 plays a pivotal role in HIV prevention research. Data from FHI 360 research informed some of the report’s findings, such as those on treatment as prevention, male circumcision and microbicides. Ward Cates, MD, MPH, President Emeritus and Distinguished Scientist with FHI 360 along with other leaders in the field, was recognized for the contributions he made to the report.

    Research and Reality offers four key recommendations:

    • Launch complex trials to answer complex questions
    • Map rollout beyond pilot projects
    • Invest in innovative approaches to virologic suppression
    • Align programs, models and funding to stay on track to end AIDS

    Click here to learn more about the AVAC Report 2013: Research and Reality.

  • In Ghana, men who have sex with men often fail to access critical HIV information and services due to deep-rooted fear of social stigma. The Ghana Men’s Study, conducted in 2011,1 revealed a high level of HIV prevalence among men who have sex with men in five sites in Ghana (17.5 percent), with the highest rates in the Greater Accra and Ashanti regions: 34.4 percent and 13.6 percent respectively. This study also found that less than half of the men who have sex with men population surveyed had been reached with HIV prevention services.

    Since 2010 year, the Strengthening HIV/AIDS Response Partnership with Evidenced-Based Results (SHARPER) project, funded by the U.S. Agency for International Development and implemented by FHI 360, has worked to reduce HIV transmission among men who have sex with men and other most-at-risk groups. The project operates in 30 districts with high HIV prevalence, with the goal of reaching 178,000 individuals with health behavior messages and improved access to health services by June 2014.

    Before 2012, SHARPER relied on peer education alone to reach this key population. We found, however, that less than 10 percent of the men in this group referred by peer educators for HIV testing were positive. Clearly, new strategies were needed to identify those most at risk of HIV and link them with prevention and care services.

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  • Realizing the full potential of microbicides for women’s HIV prevention

    The need for better HIV prevention options for women has driven the search for a microbicide, a product that could be used to reduce the risk of HIV infection. Microbicides hold promise as a new method that women can control — or at least initiate —to protect themselves from HIV.

    Progress in clinical trials suggests that an effective microbicide, which could be inserted in the vagina or rectum, may be within reach. But as we prepare for the eventual introduction of a microbicide, we must recognize that women will still face gender-related barriers to its use.

    With support from the U.S. Agency for International Development, FHI 360 conducted two gender analyses — one in Kenya and another one with Sonke Gender Justice in South Africa — to identify these barriers and ways to address them. We reviewed microbicide studies, analyzed HIV and gender policies and population-level data, and interviewed key stakeholders. Results of the analysis were presented today at the International Conference on AIDS and Sexually Transmitted Infections in Africa. Notably, many of the barriers identified are not exclusive to microbicide use; they also apply to other areas of women’s sexual and reproductive health and can be addressed now.

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  • Fighting HIV/AIDS while strengthening the national health system: A winning combination in Zambia

    What will it take to get to zero? The search for answers to this question will be a major focus of this week’s International Conference on AIDS and Sexually Transmitted Infections in Africa, the largest gathering of its kind on the continent. In Zambia, while we are still a long way off from zero, we have made monumental progress in the fight against HIV and AIDS.

    Since May 2009, the Zambia Prevention, Care and Treatment Partnership (ZPCT II) project, with support from the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR), has both strengthened and expanded access to quality HIV/AIDS services in Zambia. In close partnership with the Government of Zambia, the project operates in six provinces (Central, Copperbelt, Northwestern, Luapula, Northern and Muchinga), supporting services in 60 percent of the nation’s districts and nearly 50 percent of the government health centers in the supported provinces.

    ZPCT II provides a comprehensive package of HIV/AIDS services that is improving the health and well-being of millions of people living in Zambia. Services include HIV testing and counseling, prevention of mother-to-child transmission (PMTCT) of HIV, clinical care, male circumcision and antiretroviral therapy, which are supported by strengthened laboratory and pharmaceutical systems. Nearly 40 percent of Zambians receiving antiretroviral therapy access these services at ZPCT II-supported sites. Over 2.9 million people have received counseling and testing services, and 70,000 men have been circumcised through the project. Over 870,000 pregnant women have received PMTCT services in ZPCT II-supported health facilities, which has greatly assisted the Government’s push to eliminate mother-to-child transmission.

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  • A world without AIDS? A promising approach is bringing Vietnam closer

    For those of us who work in the field of HIV, words like “eradication” or “elimination” are not commonly used. Yet, new evidence and tools suggest that getting to zero might just be possible if we look at HIV through a fresh lens and focus our limited resources in strategic ways. As World AIDS Day nears, an example in Vietnam shows one promising approach.

    Vietnam is at a tipping point. The country is working hard to scale up methadone maintenance treatment for injecting drug users and to provide antiretroviral (ARV) treatment for those living with HIV. External resources, however, are declining and every dollar (or Vietnamese dong (VND)) makes a difference. The cascade of HIV care — an approach that links prevention outreach, testing and treatment services across a continuum of care — helps identify the key opportunities to improve services to stop the spread of HIV. This tool has come to Vietnam at a critical time. Vietnam’s HIV epidemic is still in a concentrated phase, with the highest seroprevalence among populations at higher risk. These include injecting drug users, female sex workers and men who have sex with men.

    Using the cascade — in every facility, commune, district and province — helps Vietnam monitor HIV service system performance and focus its remaining human, financial and programmatic resources on the ultimate aim of the HIV response: viral suppression. The cascade approach identifies “leaks” in the system to target resources on interventions that diagnose people with HIV, initiate ARV treatment quickly and sustain those individuals with continued care. Knowing where the drop-offs are most pronounced can assist decision makers and service providers in implementing system improvements and service enhancements that make the greatest impact on individuals, communities and Vietnamese society.

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  • The Joint United Nations Programme on HIV/AIDS (UNAIDS) has released their 2013 report, AIDS by the Numbers, which contains its latest data on the state of the epidemic globally and the progress made over the last decade. The report shows the world is coming closer to ending the AIDS epidemic but that significant challenges remain in getting to zero.

    In 2012, an estimated:
    • 35.3 million [32.2 million – 38.8 million] people globally were living with HIV
    • 2.3 million [1.9 million – 2.7 million] people became newly infected with HIV
    • 1.6 million [1.4 million – 1.9 million] people died from AIDS-related illnesses

    AIDS by the Numbers presents a wealth of data on a range of topics, such as HIV infections, access to treatment and AIDS-related deaths, along with regional statistics on HIV.

    Learn more about AIDS by the Numbers.

    Follow @UNAIDS to join the conversation.

  • Promoting male involvement in Uganda

    Since August 2012, the Elizabeth Glaser Pediatric AIDS Foundation (EGPAF) has partnered with FHI 360 to engage men in the prevention of mother-to-child transmission (PMTCT) of HIV and other family planning services in Uganda. The project, titled, “Promoting Constructive Male Engagement to Increase Use of PMTCT Services,” encouraged clients to seek HIV/AIDS care and treatment services at eight health facilities in the Kabale District of Uganda.

    Studies have shown that male involvement in PMTCT and other family planning activities can reduce the risks of vertical HIV transmission (mother-to-child) and infant mortality by more than 40 percent. Educating male partners about HIV in general and how it is transmitted is essential to successful, long-term approaches to eliminating HIV/AIDS. A 2008 study by the University of North Carolina at Chapel Hill and South Africa’s University of KwaZulu Natal found that male involvement in PMTCT was linked to more people taking advantage of HIV testing, antiretroviral treatment, condoms, and support for infant feeding choices. What’s more, some women say they need their partner’s support in order to access HIV prevention, care, and treatment services, including PMTCT.

    To encourage male involvement, team members from EGPAF and FHI 360 consulted with leaders in the Kabale district, including district health officials, civic leaders, religious leaders, politicians, and community groups to discuss matters related to gender and HIV and family planning. The community leaders then nominated well-respected men from their community to serve as champions (called “Emanzi” in the local language) and role models for their peers and lead discussions on gender and health issues in their communities.

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  • Efforts to prevent HIV must focus on gender equity

    The latest figures on HIV infections, as reported this week by the Joint United Nations Programme on HIV/AIDS (UNAIDS), revealed an impressive 33 percent reduction in new infections among adults and children since 2001. To continue down the road to success, future efforts must address the gender inequities that contribute to the disproportionate impact of HIV and AIDS on women and girls.

    More than half of the 35 million people living with HIV are women. In sub-Saharan Africa, almost 60 percent of people living with HIV are women. Young women between ages 15 to 24 are at highest risk of and most vulnerable to HIV infection. Closer to home, black women in the United States remain at high risk for HIV infection, and HIV-related illness is now one of the leading causes of death among black women between ages 25 to 34.

    Gender inequity is a key driver of the epidemic, making women more vulnerable to HIV in many ways.

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  • A roadside attraction in Djibouti: Community and condoms at the SafeTStop

    Whether on foot, camel, dhow, containership, tanker, or truck—traders have likely criss-crossed Djibouti and its waters for as long as there has been trade. Today, the Port of Djibouti, one of Africa’s busiest, lies at the nexus of major shipping routes between Asia, Africa, and Europe.

    From Djibouti, most goods travel inland by trailer-truck: some 800 Ethiopian truckers arrive every day. After offloading coffee, cotton, beans and other commodities from Ethiopia, truckers wait 4 to 6 days to reload with imported electronics, spare parts, construction materials, food aid and much else.

    This range of activity makes a small community, virtually unknown outside Djibouti, both important and vulnerable. It’s called PK-12 for “Point Kilometre 12″ in French, the official language. Meaning that it’s 12 km from Djibouti town, the capital and site of the port. PK-12 looks like the mother of all truckstops. Colorful vehicles lie like flattened dominoes as far as the eye can see — thousands of them.

    Understandably, drivers with several days on their hands also ferry back and forth another invisible item. About 25 percent are thought to be HIV-positive. The number of HIV-positive young women and men from the community is not known, and the stigma is too strong for even the boldest to disclose their status.

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