On Day 3, Three Women, Three Calls: Keep Mothers Alive, Make Women Count, Invest in Programs for Girls

XIX International AIDS Conference (AIDS 2012) Washington D.C. Wednesday Plenary Session Linda H.ScruggsAIDS Alliance for Children, Youth and FamiliesUnited StatesUSA and Canada © IAS/Ryan Rayburn - Commercialimage.net

XIX International AIDS Conference (AIDS 2012) Washington DC, Wednesday Plenary Session, Linda H. Scruggs. © IAS/Ryan Rayburn – Commercialimage.net

Day three of the XIX International AIDS Conference opened with an impassioned plenary by three powerful women speakers, calling for more concerted action for women and girls living with HIV, particularly adolescent girls.

Dr Chewe Luo, Senior Advisor HIV/AIDS, UNICEF, spoke about the Global Plan to Eliminate New HIV Infections in Children by 2015 and Keeping Their Mothers Alive. Targets of the plan include: 1) Reducing infections in children by 90%. (In 2011, 333,000 children were infected with HIV, with 29% of new infections in Democratic Republic of the Congo, Nigeria and Malawi.) 2) Reducing HIV-related maternal deaths of women during pregnancy, delivery or post-delivery, by 50% by 2015.  3) Eliminating mother-to-child-transmission.

Luo highlighted the benefits of giving triple therapy or single dose Nevirapene throughout breast feeding; this could reduce mother-to-child-transmission to less than 5%. She described pilot studies in 11 countries and improvements in access to antiretrovirals (ARVs) for women: from 48% in 2010 to 57% in 2011. Despite improvements in Eastern and Southern Africa, the Caribbean, Eastern Europe and Central Asia, “we still need to do better in Western Africa,” she said. The decline in HIV infections in children was roughly 10.8%  from 2010 to 2011 but, “this is not enough,” said Luo. “We should have reached 20% by now.”

She cautioned that treatment should have started earlier for pregnant women and cited several options that countries have, mostly based on cost: Option A and B which are treatment therapies for the mother for a limited time and the newer Option B+ which provides triple ART for pregnant women for life.

“We will not achieve the goal of eliminating PMTCT without some serious innovations. And that’s what this strategy [Option B+] is about,” said Luo.

OPTION B PLUS: BOLD CHOICE TO SAVE MOTHERS WITH HIV IN MALAWI

Malawi is the first country to implement Option B+. “We need to look at PMTCT as a component of ART and access treatment early,” said Luo. “This is the bottom line for me.”

“Option B+ must be scaled up. I applaud Malawi for being so bold.” Benefits of Option B+ include reduced infant HIV infection.

Luo then turned her attention to the “unacceptable” percentage of children not receiving ART. “We are failing to reach children,” she said.

She ended with a call to action. We need to: 1) simplify our prevention approach and integrate PMTCT and ART programs at the community level; 2) introduce innovative approaches to reach adolescent girls and pregnant teens; 3) change treatment regimens for children; and 4) collaborate with community groups.

GENDER EQUITY AND EMPOWERMENT: LINDA’S STORY

Linda Scruggs, a consultant and a woman living with AIDS, delivered an inspirational account of her own struggles and brought her rousing comprehensive agenda to “Make Women Count” and end gender discrimination and stigma to a standing ovation. Scruggs told many stories of both gender inequity and gender empowerment.

“For the last 20 years, women have been asking for an international platform for their rights, to count us in. Today I stand to give us direction and a recipe for change. We want women  to work with women that have the tools for us, by us, with us. … It is not enough to create a task force or write a paper, what we need is to be part of the solution. We are the Mothers of the Earth.”

Linda reflected: “What does a woman with no self- esteem look like?  What does a woman whose uncle molested her look like? What is a woman who can’t read or write, broken and voiceless? That woman was me.”

Linda told stories of women, broken or affected by disease. “We are at the table and a force to be reckoned with. We need a big change and need to create jobs and training for HIV positive women.”

UNFINISHED AGENDA: PROTECTING  ADOLESCENT GIRLS

Dr. Geeta Rao Gupta, Deputy Executive Director of UNICEF, also made the case to turn the tide for adolescent girls and highlighted the need for gender equality. Adolescent girls aged 15 to 24 bear the brunt of the epidemic. Of the 4.8 million young people with AIDS, 3 million of them are girls.

The challenges of adolescent girls are immense: early sexual debut, child marriage, increased risk of HIV and STIs, sexual violence, and risk of early pregnancy and HIV infection. Many are forced early into transactional sex to survive or they depend on older men to survive. Most lack basic information on condoms or sex education.

Geeta offered recommendations to accelerate the pace of protection for adolescent girls:

  1. We need relevant national plans for high impact with emphasis on girls. Few country plans include anything about adolescent girls.
  2. We need to educate girls — empower them to make choices.
  3. We need to start early; make adolescents visible in routine data systems and follow their health status after age 5. (Right now, they don’t appear in the data unless they get pregnant or contract HIV and then they are included with adult data.)
  4. We need to invest in innovations to reach adolescent girls through social media and networks.
  5. We need to engage with adolescents as partners.

As Anthony Lake of UNICEF has so eloquently said: “We invest so much in keeping girls alive in their first decade of life. We must not lose them in the second.”

We need a world that is AIDS-free and fair for all women and girls. That must be our legacy.

Barbara Ayotte is MSH’s director of strategic communications.

The Vision for Success Beyond MDG 6: Chronic NCDs, Health System Strengthening, and UHC

2012 July 22 AIDS 2012 Satellite Session: Beyond MDG 6

Panelists at AIDS 2012 Satellite Session: Beyond MDG 6, July 22, 2012. (Photo credit: S. Holtz/MSH)

On Sunday, July 22, 2012, Management Sciences for Health (MSH) hosted a satellite session, Beyond MDG 6: HIV and Chronic NCDs: Integrating Health Systems Towards Universal Health Coverage at the XIX International AIDS Conference (AIDS 2012). The session panelists were (left to right): Dr Ayoub Magimba, Till Baernighausen, Dr Jemima Kamano, John Donnelly (moderator), Sir George Alleyne, Dr Doyin Oluwole, and Dr Jonathan D. Quick

This week at the XIX International AIDS Conference — as panelists and pundits debate whether an AIDS-free generation is actually possible — we must not neglect the other chronic diseases that remain an emerging and alarming threat to both aging HIV-positive and sero-negative populations in these settings. Today, chronic non-communicable diseases (C-NCDs), including cancer, lung and heart disease, and diabetes, kill over 28 million people annually in low and middle-income countries, many of whom are HIV-positive.

According to Till Baernighausen of the Harvard School of Public Health, the total number of HIV-positive people aged 50 years and older is likely to triple over the coming decades from 3.1 million in 2011 to maybe 9 or 10 million in 2040. “We would really expect dramatic increases for the need for C-NCD screening and treatment.”

TURNING THE TIDE THROUGH INTEGRATED HEALTH SYSTEMS

Once deemed a death sentence, HIV is now considered a manageable chronic condition through the use of lifelong antiretroviral therapy (ART). HIV-positive individuals are now living longer, particularly in resource-limited settings where HIV care and treatment were not previously available. In fact, through the global scale-up of HIV and AIDS services, health systems in low- and middle-income countries are now better prepared to tackle other C-NCDs — like cancers, diabetes, chronic lung diseases, and cardiovascular diseases — by leveraging the existing investments, infrastructure, and systems put in place in recent decades.

BUILDING ON THE SUCCESS OF HIV & AIDS PROGRAMS

Over a decade ago, many critics said that bringing life-saving HIV treatment to the most hard-to-reach areas would be impossible. Yet today, more than 8 million people have access to antiretroviral treatment in low-and middle-income countries. The same models used for lifelong ART can be adapted and used for managing and monitoring patients with other C-NCDs. MSH firmly believes we can apply the lessons learned from our experiences with HIV to the C-NCD epidemic. For example, service delivery models — e.g. scaling up of ART and prevention of mother-to-child transmission (PMTCT) — innovations in funding, health care financing models, pricing for drugs and laboratory supplies and equipment, and new technologies for care diagnosis, among other innovations, provide a model for chronic diseases in low- and middle-income countries.

While proven solutions to tackle such conditions exist, the global health community is only now starting to realize the importance of designing cost-efficient, integrated health systems. According to Dr. Jemima Kamano of AMPATH, “One of the hardest things for me as a practicing clinician in Africa is to sit at the HIV clinic and treat HIV patients, counsel them and give them drugs and see them improving. But the minute they develop diabetes or hypertension, then I tell them unfortunately I can’t help them.”

By integrating current health systems and leveraging the existing groundwork laid by HIV and AIDS intervention scale-up, we can leverage existing public infrastructure, pharmaceutical supply chains, and human resources management, among other developments, to benefit patients with chronic diseases.

HIV & AIDS, C-NCDS, AND UHC

HIV and other C-NCDs have serious socioeconomic consequences, often creating a financial barrier for individuals in need of proper care and treatment, and forcing them to pay high out-of-pocket fees. Despite advancements in service delivery, only twenty countries worldwide currently have Universal Health Coverage (UHC) plans in which everyone can receive basic health services.

While some advocates in the AIDS community may see UHC as a threat to the provision of HIV & AIDS resources, others see it as a solution. Sir George Alleyne from the Pan American Health Organization (PAHO) reminds us that UHC is “feasible, socially desirable, and economically possible.”

“We have acceptance that UHC is possible. It is a myth that poor countries cannot afford UHC. There is no country that cannot afford UHC,” Sir Alleyne says. “It is a matter of social justice.”

According to Dr. Jonathan D. Quick, President and CEO of Management Sciences for Health, “UHC is becoming the driving vision for prevention, care and treatment of, and assuring access for, HIV positive and HIV affected people. They live long enough to get chronic diseases and to care for children — and they need the services that are provided through universal health coverage programs.”

The long-term nature of chronic diseases, including HIV, poses many challenges for the health system, but it is crucial that the prevention, care, and treatment of chronic disease be integrated in order to save many more lives.

MSH believes that in order to effectively combat the rise of C-NCDs — and turn the tide against HIV and AIDS — we must strengthen current health systems while leveraging existing platforms and ensuring access at an affordable cost in the context of UHC.

For a more in depth discussion on this topic, watch the webcast of MSH’s recent panel at the International AIDS Conference (via Kaiser Family Foundation).

Gloria Sangiwa, MD, is Management Sciences for Health’s global technical lead for chronic non-communicable diseases and the director of technical quality and innovation in MSH’s Center for Health Services.

Seasoned Experts Weigh in on PEPFAR

A cast of seasoned AIDS experts gathered at the Center for Strategic and International Studies (CSIS) on Saturday evening, July 21, to weigh in on the President’s Emergency Plan for AIDS Relief (PEPFAR) on the eve of the XIX International AIDS Conference, dubbed “AIDS 2012”.

The conference is taking place in the USA for the first time in 20 years thanks to President Obama’s lifting of the travel ban on HIV-positive visitors.

“What has been PEPFAR’s strategic significance?”

An illustrious panel including Ambassador Eric Goosby (United States Global AIDS Coordinator), Ambassador Mark Dybul (former United States Global AIDS Coordinator), and Dr Anthony Fauci (Director of National Institute of Allergy and Infectious Diseases, NIAID) discussed the first topic: “What has been PEPFAR’s strategic significance?”

Dr Fauci, who was one of the architects of PEPFAR, talked of the humanitarian and moral responsibility that George Bush felt. He mentioned an African male comment that “PEPFAR is the best thing that ever happened to Africa.”

Amb Dybul, another architect of PEPFAR, reiterated that the “driving force was moral responsibility” but also commented on a “moral visceral reaction” that Pres Bush felt whenever he heard people say that Africans were too poor to take AIDS medicines or that they were too promiscuous. He explained that Pres Bush believed that it “represents the conscience of the US people.” He told a story of how a patient described PEPFAR by saying “it means that Americans care about us.” Amb Goosby commented that Pres Bush created PEPFAR because of the moral imperative and the fact that we could respond. He noted “talk is cheap; actions speak louder than words.”

All three panelists voiced concern about fatigue with respect to humanitarianism and ethical issues, such as HIV and PEPFAR, and warned the audience that we cannot afford fatigue 18 months prior to the re-authorization of PEPFAR. This led to the conclusion that we must shift the message to “we can control AIDS,” “we can fix the problem,” and we can create an “AIDS-free generation.”

The second panel shared their answers to the question “What has PEPFAR taught us, for good and bad?”

Dr. Wafaa el Sadr of ICAP praised PEPFAR as providing as place for innovation, for learning on the ground, for fast translation of science into action followed by enormous scale up, and for problem solving by health care workers and policy makers. She thinks the early perception was that PEPFAR was run by Washington DC and not owned locally, but then argued that PEPFAR could not have achieved what it did without country ownership. Dr el Sadr also described as a tragedy the people who have the courage to have an HIV test, only to test positive, but have a CD4 count above the level eligible for treatment.

Dr Alex Muganzi of Uganda described PEPFAR as “the best things that has happened to Africa with respect to HIV.” He described the early days when medicines were very expensive and health care workers had to choose who would receive them; he equated it to ‘acting like God.” PEPFAR revolutionized HIV treatment, shattered misconceptions that Africans cannot adhere to an HIV medicine regimen, and increased the role of civil society.

Dr Jeff Springer, drawing on his experience in Zambia, noted the prevailing beliefs that patients would not come due to stigma, that labs could not handle HIV tests, that patients could not take medicines … all these preconceptions were blown away, leading to a “paradigm shift about what is possible.”

“What Should PEPFAR look like in five years?

The last panel brought together Dr Chris Beyrer, Dr Kevin De Cock, Dr Tom Quinn and Dr David Serwadda to debate: “What PEPFAR should look like in five years” and in particular, reaching an “AIDS-free generation.”

Dr Beyrer cautioned that HIV prevalence will increase as more people live longer thanks to HIV medicines. He expects declining incidence and lower levels of transmission. He cautioned, however, that HIV epidemiology keeps changing and we “can’t get to an AIDS-free generation without addressing these populations”: sex workers, men who have sex with men, and injection drug users.

Dr De Cock added that the term “AIDS-free generation” also means virtual elimination of mother to child transmission and that all persons with HIV access medicines early with the best available medicines. He questioned why none of the previous panelists mentioned medical male circumcision, to which Dr Quinn commented that it’s “the most cost-effective prevention intervention today.”

Dr Serwadda requested that we look longer than five years. He focused heavily on country ownership, challenged PEPFAR to engage countries more, and insisted that “governments must put their mark on it.” With respect to most at risk populations, Dr Serwadda suggested that countries should look at the epidemiology, identify the new infections and put the money there; he predicts that at some point, “countries will come around and put the money there.”

PEPFAR Featured in Journal of AIDS

The Saturday evening panel discussion coincided with the launch of a special issue of the Journal of AIDS: “PEPFAR: Its Vision, Achievements and New Directions,” highlighting a “decade of data and experience.” Read the special JAIDS issue on PEPFAR.

Sara A. Holtz, DrPH, MPH, is senior technical officer at Management Sciences for Health.

Webcast: Beyond MDG 6: HIV & Chronic NCDs: Integrating Health Systems Towards Universal Health Coverage

Watch the entire session:

(Via the Kaiser Family Foundation website.)

SESSION DETAILS

While building on the momentum of the UN Summit in September 2011, this satellite recognizes that people living with HIV both treated and untreated, suffer from co-morbidities due to chronic NCDS. This satellite will examine the role of chronic NCDs and their link with HIV. More specifically, we will review lessons learned from the AIDS Decade of the 2000s and determine what lessons can be leveraged and applied beyond 2015 in the context of an emerging global burden of chronic NCDs. We will also discuss how we can use this current momentum to re-engineer the primary health care model so that it leads to sustainable, cost-efficient, comprehensive and integrated health systems that facilitate the achievement of universal health coverage for chronic NCDs in lower and middle income countries. Partners include: MSH; Government of Tanzania; Sir George Alleyne (Pan American Health Organization); AMPATH; Harvard and University of KwaZulu-Natal, South Africa.

Mildred, a mother and patient with STAR-E, Uganda

Mildred, a mother and patient with STAR-E, Uganda

Welcoming remarks

  • John Donnelly, United States
  • Dr. Jonathan Quick, United States

Why We Still Need Advocacy for Chronic NCDs Post UN-Summit, How Do We Create Shared Responsibility of This dual Epidemic and Why Here at the AIDS 2012 Conference

  • Sir George Alleyne, Barbados

What We Know About HIV Today and Its Implication Beyond 2015

  • Till Baernighausen, United States

Evidence-based service delivery models for care and treatment of persons with HIV

  • Jemima Kamano, Kenya

Leveraging Public and Private Investments in Global Health to Combat Cervical and Breast Cancer / Pink Ribbon Red Ribbon Initiative

  • Doyin Oluwole, United States

The Tanzania Model and Government Perspective on Tackling the Dual Epidemics

  • Ayoub Mmbando, United Republic of Tanzania

Join MSH: Events, Presentations, Booth 162

Cross-posted on MSH’s Global Health Impact blog.

Over 40 Management Sciences for Health (MSH) staff from around the world will join the twenty thousand health workers, activists, researchers, donors, and policy makers at the XIX International AIDS Conference, “Turning the Tide Together”. Visit us at the following events, poster and oral presentations, Booth #162, or online.

Catch live blog updates, July 22-27, and follow us on Twitter with #AIDS2012, #PMTCT, and #OptionBplus. (Kaiser Family Foundation is providing live conference webcasts.)

MSH EVENTS

Join MSH and partners at these 2012 International AIDS Conference featured events:

Beyond MDG 6: HIV and Chronic NCDs:
Integrating Health Systems Toward Universal Health Coverage

Sunday, July 22, 11:15 – 13:15, Session Room 2

  • Moderated by John Donnelly, global health journalist
  • Panelists
    • Dr. Jonathan D. Quick, Management Sciences for Health
    • Sir George Alleyne, Pan American Health Organization
    • Till Baernighausen, Harvard School of Public Health
    • Dr. Jemima Kamano, AMPATH
    • Dr. Doyin Oluwole, Pink Ribbon Red Ribbon Initiative at The George Bush Institute
    • Dr. Ayoub Magimba, Tanzania Ministry of Health and Social Welfare

Facebook event

Prevention of Vertical Transmission and Beyond:
How to Identify, Enroll, and Retain Children in Treatment Programmes in Resource-Limited Settings

Sunday, July 22, 15:45 – 17:45, Mini Room 1

  • Co-chaired by Nick Hellmann, EGPAF and IAS-ILF, and Chewe Luo, UNICEF
  • Panelists
    • Erik Schouten, Management Sciences for Health
    • Angela Mushavi, Ministry of Health Zimbabwe
    • Dorothy Mbori-Ngacha, UNICEF
    • Nandita Sugandhi, CHAI
    • Scott Kellerman, Management Sciences for Health

HIV & Health Systems Strengthening in Fragile States:
What We Don’t Know, Can Kill…What Approaches are Needed to Improve HIV Prevention, Care, and Treatment?

Thursday, July 26, 18:30 – 20:30, Session Room 5

  • Moderated by Susannah Sirkin, Physicians for Human Rights
  • Panelists:
    • Dr. Jonathan D. Quick, Management Sciences for Health
    • Amin Islam, International Rescue Committee
    • Peter Mutanda, International Rescue Committee – Kenya
    • Steve Solter, Management Sciences for Health

Special Satellite Event

Care and Treatment for People with Chronic Conditions:
What can we learn from the HIV Experience? A Health Systems Perspective

Sunday, July 22, 11:15-13:15, Session Room 8

Dr. Jonathan D. Quick, MSH President & CEO, will deliver closing remarks.

  • Sponsored by World Health Organization, UNAIDS and the Global Health Workforce Alliance
  • Co-chaired by Dr. Ariel Pablos-Méndez and Dr. Masato Mugitani, this special event features: Dr. Margaret Chan, Mr. Michel Sidibé, Paul de Lay, Dr. Sania Nishtar, Dr. Jarbas Barbosa de Silva, Jr., Dr. Milly Katana, Dr. José M. Zuniga, and Dr. Hiroki Nakatani. Moderated by Dr. Richard Horton (Editor-in-Chief, The Lancet).

MSH Affiliated Events

Voluntary Pooled Procurement of HIV/AIDS Commodities:
What Does it Take to Make VPP Achieve its Objectives and Maximize its Benefits?

Sunday, July 22, 09:00 – 11:00, Mini Room 9

  • Organized by the Grant Management Solutions Project
  • The Global Fund to Fight AIDS, Tuberculosis and Malaria established the voluntary pooled procurement (VPP) for core health products. VPP aims to increase the speed of delivery, and ensure the supply, reliability and quality of health products, secure attractive prices for them, and help strengthen local procurement and supply management capacity, states the Global Fund’s website. What hinders and what helps VPP succeed will be the topic of this panel discussion.

Global Fund Country Coordinating Mechanisms:
Providing Oversight and Leadership during the Transitional Funding Period – A Capacity Building Session

Sunday, July 22, 11:15 – 13:15, Mini Room 1

  • Organized by the Grant Management Solutions Project and The Global Fund
  • This two hour session in English is designed for CCM members, Global Fund implementers, technical support agencies, civil society and development partner constituencies involved in CCM governance and oversight. The session will focus on grant oversight for the current transitional funding period 2012-2014: 30 minutes will be devoted to presentation, 30 minutes to Q&A and 1 hour to smaller group work using case studies to train on analyzing and solving problems of oversight and prioritization. These sessions will address the core challenge of the 2012-2014 period for GF beneficiary countries – how to successfully steward their grants so as to maintain patient coverage and access to quality services. A French session will be held at this time in Session Room 9.

Supply and Demand of HIV/AIDS Commodities:
Can the Global Market and National Supply Chains Support Continued Rapid Scale Up of HIV/AIDS Treatment?

Thursday, July 26, 18:30 – 20:30, Mini Room 2

  • Organized by The Partnership for Supply Chain Management and USAID Global Health Bureau Office of HIV/AIDS
  • The international community has agreed to a goal of universal access by 2015. If donors increase funding to provide treatment to 15 million, can a sufficient volume of ARVs and other commodities be manufactured and distributed in target countries? Will national supply chains be able to receive and distribute many times the current volumes? Participants will learn about the integrated nature of global supply chains to meet public health needs, and discuss obstacles in the global supply chain to meeting the goal of access to HIV/AIDS treatment.

Visit us at Booth #162

More information on:

  • Prevention of Mother-to-Child Transmission (PMTCT) and Option B+ (Sunday & Wednesday)
  • Health Systems Strengthening (Monday & Thursday)
  • Pharmaceutical Management (Tuesday)

Follow live conference updates

See you in DC or online, “turning the tide together”!