How Do You Transform Global Health?

At an International AIDS Conference focused on finding new ways forward in the HIV response, universal health coverage (UHC) has emerged as a promising path. Done right, UHC reforms can make health systems more fair, strengthen healthcare access for people living with HIV, and improve the sustainability of HIV financing. But strong activism is necessary to ensure that these reforms don’t just reinforce existing inequalities.

These were the messages from MSH’s panel session on UHC and HIV, cosponsored by the International HIV/AIDS Alliance and Global Youth Coalition on HIV/AIDS. The discussion, headlined by former Australian High Court justice and human rights advocate the Hon. Michael Kirby, demonstrated the key role of HIV activists—especially people living with HIV—in making UHC work at the national and global level.

The willingness of the HIV community to engage with UHC efforts continues to grow. The UHC community must respond in kind, taking on broad lessons from the HIV response. That’s what could make UHC a transformative global health agenda in the post-Millennium Development Goal era.

Here’s what the audience—in person and online—had to say about lessons from HIV for UHC:

Videos: Dr. Gloria Sangiwa: Women Lead on Chronic Diseases

Dr. Gloria Sangiwa, Global Technical Lead of Chronic Diseases at Management Sciences for Health (MSH), reflects on the 20th International AIDS Conference (AIDS 2014).

In the first video, Sangiwa describes the exciting opportunity for leveraging the HIV platform, thanks to the work of PEPFAR, to treat the whole person–not just the disease.

In the second video, Sangiwa elaborates on why women leaders — from personal health, to family, health provider, community, policy level, and more — are a critical component to stepping up the pace on HIV and chronic diseases.

Video 2:

More about MSH’s work on chronic diseases

 

 

Video: Meet Chinwe Owunna

Chinwe Owunna of Management Sciences for Health (MSH) describes the active surveillance approach used by the US Agency for International Development (USAID)-funded Systems for Improved Access to Pharmaceuticals and Services (SIAPS) Program in Swaziland to increase understanding of medicines safety and risk/benefit context for TB and HIV patients.

Watch video

More about SIAPS

Working toward an AIDS-free Generation: President Clinton Highlights Rwanda’s Successes

On Wednesday, July 23, I attended a special session of the 20th International AIDS Conference (AIDS 2014), called “Putting Patients First To Improve Outcomes and Programme Efficiency.”  This year, the theme of the one-week event, which gathers about 12,000 participants from across the globe, is “Stepping Up the Pace.” The objectives include indeed to find a cure and a vaccine for this terrible disease, which has already taken the lives of about 38 million people since its discovery in 1981.

This session was led by President Bill Clinton, 42th President of the United States, and founder of the Clinton Health Access Initiative (CHAI). Over the course of an hour, President Clinton talked about the progress and challenges made during the past years concerning the fight against HIV & AIDS.

First, he paid tribute to the AIDS delegates who lost their lives in the tragic accident of the plane, MH17. Then, he recapitulated the evolution in provision of AIDS medicines, and reminded us that, even though 13 million patients are getting treatment today, “the achievements shouldn’t be an excuse to slow down, …and an AIDS-free generation is within our reach.”

President Clinton also mentioned that international funding is decreasing, and therefore emphasized the importance of being more efficient.

Among other examples, he quoted the story of Rwanda, whose Ministry of Health (MOH): “offers the most remarkable in achieving efficiency in leadership”.

As a Rwandan delegate, I was glad to hear that.  Since his first visit in Rwanda in 1998, the country has made remarkable progress, and is moving toward the 2020 Vision, which is to be 100 percent free of external aid. “Rwanda has a great story,” he said, and, in collaboration with 25 US medical institutions, the government is training people to help others to stay alive.

The country has indeed achieved major results. Among them, thanks to the community based health insurance scheme (CBHI), the most vulnerable, who are about 25 percent of the population, are now getting free access to health care. Moreover, from 2010 to 2012, the performance based financing (PBF) system permitted the annual average number of HIV provider initiated testing to more than double, passing from 33,038 to 84,605, while the HIV voluntary counseling and testing (VCT) increased 21 percent (from 133,231 to 160,833).

And, as President Clinton said, even if “more has to be done”, this made me feel proud to be Rwandan.

MSH has been active in Rwanda since 1983, and is currently supporting the MOH through the USAID-funded Integrated Health Systems Strengthening Project (IHSSP) in five major health system areas.

Candide Tran Ngoc is a senior communications specialist for IHSSP in Rwanda.

Correction, August 5, 2014: This post was updated to fix two inadvertent errors: 1) MSH has been in Rwanda since 1983, not 1973. 2) By September 2012, over 90 percent of all eligible Rwandans were enrolled in CBHI. Since then, the percentage of eligible Rwandans has dropped to around 70 percent. For more information, download the Rwanda MOH’s “Annual Report: Community Based Health Insurance: October 2012″ (PDF).

Lessons from HIV for TB: Thursday, 18:30

Don’t miss the networking and drinks reception tonight, July 24, in room 101-102, with World Bank Group, USAID, Results International, MSH, and more.

Learning the Lessons from HIV for Improved TB Control and Beyond.

Learning the Lessons from HIV for Improved TB Control and Beyond.

THSA10 Learning the Lessons from HIV for Improved TB Control and Beyond: a Panel Discussion and Reception
Non-Commercial Satellite
Venue: Room 101-102
Time: 24.07.2014, 18:30 – 20:30

“Tap the potential” of the private sector tonight

Join us tonight in room 111-112 for “Tap the potential: The role of the private sector in stepping up the pace of supply of HIV/AIDS commodities.”

The Partnership for Supply Chain Management, Inc., to host satellite session Wednesday, July 23, 18:30-20:30.

The Partnership for Supply Chain Management, Inc., to host satellite session Wednesday, July 23, 18:30-20:30.

Calling for a You-Turn for Public Health: Don’t Criminalize Gays, People Living with HIV

Since HIV was first identified in sub-Saharan Africa, Uganda has distinguished itself as a leader in developing and implementing an effective HIV response. In recent years, however, HIV incidence has been increasing in the country, and a series of restrictive, punitive measures have replaced the common sense, public-health approach that had set this beautiful country apart.

This year, Uganda joined Nigeria and a handful of other sub-Saharan African countries that have passed, or are considering, repressive, egregious laws criminalizing HIV transmission and homosexuality–laws that are regressive and disastrous from a public health point of view.

Among other things, the anti-homosexuality law in Uganda requires Ugandans to report anyone who may be homosexual to the authorities. Anyone. This means mothers turning in sons, fathers turning in daughters. Anyone.

Meanwhile, the Ugandan “HIV Prevention and Control Act” criminalizes “attempted” or “intentional” transmission of HIV, with fines of up to ten years in prison, and mandates testing for HIV of pregnant women, their partners, and for all accused of rape, not convicted, accused. It further allows for court ordered disclosure of HIV status—in some circumstances without the individual’s consent. While Ugandan President Yoweri Museveni has not yet made it official, it is likely he will sign the HIV bill any day.

MSH has worked in Uganda for over 15 years, measurably improving the health of Ugandan women, men and children, and helping to save the lives of people needing HIV & AIDS prevention and treatment. The new law’s restrictions on “abetting” homosexual relations will impair efforts by healthcare providers and development organizations like MSH to provide comprehensive prevention, counseling, testing, and clinical care and treatment services for vulnerable people living with HIV or those at risk of HIV infection.

Some say that far-right US interests have fueled the fear and fomented discrimination of gay people in Uganda and elsewhere. Regardless of the source, sadly some anecdotal reports suggest that many Ugandans do not see a problem with the new laws.

The LGBT communities in Africa, Asia and elsewhere are unfortunately no strangers to these insults; and I have been trying to formulate a response to these unfortunate turn of events. My conclusion, in light of such intolerance against a select group of people for petty political gains, is simply to stand up and be counted. So in solidarity with those who suffer from these crude attempts at discrimination, I state proudly what my family, friends and colleagues have long known and supported: I’m a gay man. And, as a gay man, I will only be able to participate in the rebuilding of Uganda’s HIV response from afar. So, while MSH has multiple projects working in Uganda, serving hundreds of thousands of Ugandans, if I were to go and help my MSH colleagues on the ground, they would be compelled to turn me into the authorities or face prosecution themselves. I cannot put my colleagues at risk.

How many others face this quandary?  And what of our gay and lesbian friends and colleagues working and living in Uganda, shrouded in secrecy? What will become of them?

What about the Ugandans who must hide who they are—even if it means not getting tested for HIV, or not adhering to antiretroviral treatment for fear of this specific sort of stigma and discrimination that the Ugandan laws have created?

More people will go underground. More will hide their HIV status. Fewer people will get tested. More HIV transmission will occur.

I stand with those whose courage is head and shoulders above mine: Uganda’s own Frank Mugisha, executive director for Sexual Minorities of Uganda (SMUG), Uganda’s umbrella LGBT rights organization, who was out of the country when President Museveni signed the anti-homosexuality law but then chose to return knowing full well that he might be targeted for persecution, prosecution or worse.

I stand with Dr. Paul Semugoma, winner of this year’s International AIDS Conference Elizabeth Taylor Human Rights Award. Dr. Semugoma remains in exile from Uganda, his home country, because him being gay and having the temerity to state it, unashamed, publicly, put him in grave danger in his country of birth.

I stand with Binyavanga Wainaina, the wonderful Kenyan author who decided to tell the world he was gay in response to Uganda’s and Nigeria’s laws. His book , “Someday I will write about this place,” is as universal a coming of age memoir as any I’ve ever read.  Following their example, willing to proclaim simply who they are, raising my hand and adding to their voice seems a paltry response.  But it’s the most potent tool I can think of.

I stand with the anonymous men and women—gay and presumed gay—who are languishing in fear or in prison and those who are ill who don’t feel they have the option of seeking care for fear of the response from those in their communities, the clinics, or the authorities.

I stand with the many others who have the courage to stand up and say, this is who I am. Do not criminalize me.

In speaking up, gay and straight, we say: all people deserve the opportunity for a healthy life – living with HIV, at high risk of infection, in any country or region—no matter how far from a health center you may have been born: you are worth seeing, testing, and treating. You have as much right to life and health as President Museveni of Uganda, President Jonathan of Nigeria, those who make the laws, and every one.

We will continue to work with global and local partners to support Uganda’s and Nigeria’s efforts to strengthen their health systems. But, these laws will make reducing HIV transmission, and preventing maternal and child deaths much harder.

Health includes dignity. We hope that as more people—gay and straight, living with HIV, and allies–stand and work together, more people in Uganda and around the world will believe: All people deserve the opportunity for a healthy life.  One thing is clear:  we do not improve health and humanity by stigmatizing and criminalizing sexuality or living with HIV.

Scott Kellerman, MD, MPH, is the Global Technical Lead for HIV & AIDS in the Center for Health Services at MSH.

{Photo credit: Rui Pires/MSH.}

{Photo credit: Rui Pires/MSH.}

Related

Anti-Homosexuality Act is a Step Backward for Uganda

New law in Uganda likely to set back gains made in HIV & AIDS

HIV Lessons for Universal Health Coverage (#Lessons4UHC)

Post updated, July 22, 18:30.

Tweet your questions and lessons for building universal health coverage on the AIDS response to @MSHHealthImpact with hashtag #Lessons4UHC.

Meet MSH Poster Presenters

The International AIDS Society accepted 17 posters by MSH staff.

(Meet more MSH staff on Wednesday and Thursday 12:30-14:30.)

Tuesday, July 21

Sam Wanamama, Uganda

Sam Wanamama presented on “Follow up of circumcised clients at 48-hours post-surgery in Uganda: reducing adverse events and reinforcing prevention messages.” {Photo credits: Christine Rogers/MSH.}

// Learn more about Strengthening TB and AIDS Response – Eastern Region >>

Monday, July 20

Megh Jagriti, Southern Africa

 Megh Jagriti, senior technical advisor, Building Local Capacity (BLC) for Delivery of HIV Services in Southern Africa. His poster is called: “Evidence based OVC programming – optimizing resources and ensuring impact in Lesotho.” {Photo credit: Barbara Ayotte/MSH.}

Megh Jagriti, senior technical advisor, Building Local Capacity (BLC) for Delivery of HIV Services in Southern Africa, presented on: “Evidence based OVC programming – optimizing resources and ensuring impact in Lesotho.” {Photo credit: Barbara Ayotte/MSH.}

// Learn more about Building Local Capacity for Delivery of HIV Services in Southern Africa >>

Oby Onoh, Nigeria [Candide Tran Ngoc presenting]

(July 20) Poster from Nigeria on “Using organizational capacity building to ensure the sustainability of community-based interventions for orphans and vulnerable children: lessons from the CUBS project in Nigeria" by Obialunamma (“Oby”) Onoh, presented by Candide Tran Ngoc.  {Photo credit: Barbara Ayotte/MSH.}

“Using organizational capacity building to ensure the sustainability of community-based interventions for orphans and vulnerable children: lessons from the CUBS project in Nigeria,” by Obialunamma (“Oby”) Onoh was presented by Candide Tran Ngoc. {Photo credit: Barbara Ayotte/MSH.}

// Learn more about Community-Based Support for OVC Project >>