Digital communications and media are now part of everyday life for many people around the world. But while people have turned to smartphones for entertainment, socializing and commerce, the health community is still working to make services, outreach and treatment digitally accessible. Examining successful applications allows us to understand what approaches might be possible for digital health services. During the COVID-19 pandemic, it is more crucial than ever that digital health resources provide support for people to access from their homes.
Put a ring on it: Four reasons to make the dapivirine ring an HIV prevention option for women and girlsWritten by
While much progress has been made to end the HIV epidemic, not enough has been done to put the power of prevention directly in women’s hands. The dapivirine ring, a flexible silicone ring inserted monthly into the vagina, can change this. If approved by regulators, the ring would be the first discreet, long-acting HIV prevention tool available specifically for women. The ring would complement daily oral HIV pre-exposure prophylaxis (PrEP) as another biomedical tool in the fight against HIV.
Recent evidence suggests significant acceptability of and demand for vaginal rings as a drug-delivery platform among women who used the dapivirine ring during clinical trials — and also among policymakers and other stakeholders in countries with a high HIV burden. To better understand these perspectives, the OPTIONS Consortium interviewed policymakers, implementers and civil society leaders in seven sub-Saharan African countries about possibilities for introduction and scale-up of the dapivirine ring. An analysis of the interviews shows widespread enthusiasm for the ring as part of comprehensive HIV prevention programming.
The increased pressure on public health systems to respond to the COVID-19 pandemic affects all routine health care, including the provision of essential HIV services. People living with HIV require regular access to treatment, but crowded public health facilities carry increased risk of exposure to COVID-19. Routine treatment sites also may be harder to reach because of stay-at-home orders, curfews and public transportation shutdowns. To maintain gains in HIV epidemic control, we must ensure that people needing antiretroviral therapy (ART) continue to receive medication uninterrupted.
Although we cannot truly compare COVID-19 with HIV, there are similarities worth exploring. As the COVID-19 epidemiological data pours in, we have learned that communities of color are at heightened risk for hospitalization and death. With the reality that the economic fallout affects minority communities more than anyone else, it is clear the odds are against us yet again. We have seen this story play out throughout the course of the HIV epidemic, with LGBTQ, black and Latinx communities enduring the brunt of the disease’s burden. These health disparities are the result of structural inequities that our nation has not yet found the resolve to address. So, just as we did in the early days of HIV, we must arm ourselves with knowledge and a community-driven purpose to protect ourselves and those around us from COVID-19.
The global health community is concerned that tuberculosis (TB) continues to disproportionately kill people living with HIV, despite the availability of TB preventive therapy. According to the World Health Organization’s Global Tuberculosis Report 2019, deaths attributed to TB among people living with HIV account for 17 percent of all TB deaths, even though people living with HIV account for only 8.6 percent of overall TB cases.
At recent global health meetings that assessed progress made against the HIV epidemic, presentation after presentation confirmed that the world is inching closer to epidemic control. The excitement at these gatherings was palpable. It would be the first time in human history that such a public health milestone would be achieved without either a cure or a vaccine.
As technical experts attending these meetings, we were struck by the critical importance of logistical and operational interventions, alongside biomedical ones, to reach the last mile. Yet, unlike the private sector, public health systems in low- and middle-income countries often remain underfunded and understaffed. This environment can make project management very challenging.
The Determined, Resilient, Empowered, AIDS-free, Mentored and Safe women (DREAMS) partnership aspires to reduce HIV infections among adolescent girls and young women in 10 sub-Saharan African countries. These countries alone accounted for more than half of the HIV infections that occurred among adolescent girls and young women globally in 2015.
DREAMS reaches beyond the health sector to address the direct and indirect factors that increase girls’ HIV risk, such as poverty, gender inequality, sexual violence and inadequate education. Interventions can include paying school fees, providing bicycles to girls who would otherwise walk long distances to school, supplying sanitary napkins for menstrual hygiene management and offering mentoring to help girls avoid early pregnancy, gender-based violence and discrimination. DREAMS is supported by the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR), the Bill & Melinda Gates Foundation, Girl Effect, Johnson & Johnson, Gilead Sciences and ViiV Healthcare.
Two young women who participate in DREAMS projects attended FHI 360’s 2018 Gender 360 Summit and discussed how DREAMS is making a difference in their lives. Here are their stories.
The focus of the global effort to end the HIV/AIDS epidemic, now 37 years on, is epidemic control, which the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR) defines as limiting the annual number of new HIV infections in a country to less than the number of deaths among people living with HIV.
Sub-Saharan Africa, home to 26 million (70 percent) of the global total of 36.9 million people living with HIV, is where the battle must be won. To succeed and sustain the gains achieved in the past 15 years, countries in Africa will need to assume greater responsibility for managing their epidemics.