Tagged: AIDS

  • 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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  • 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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  • AIDSWatch 2014: Science and advocacy coming together

    What is AIDSWatch?

    AIDSWatch is an annual event in DC. Hundreds of people come from across the United States to educate members of Congress and other senior government officials about the impact of HIV in their communities and lives and to discuss strategies for ending the HIV epidemic. Public health officials, policy advocates, leaders from community-based organizations and people living with HIV seek to gain vital support for lifesaving programs and services.

    The event includes a briefing on key policy issues and HIV-related programs, scheduled visits with members of Congress and the Positive Leadership awards reception. Participants learn about the budget and appropriations process, critical programs serving people with HIV — such as the Ryan White CARE Act and the Affordable Care Act — and effective HIV prevention strategies. The event includes a “telling your story” session to help participants communicate their experience to policymakers and networking sessions to share resources.

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  • 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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