In the last of a series of posts on the U.K. Department for International Development’s (DfID) blog examining the department’s work in Malawi, Neil Squires, DfID head of profession for health, looks at the sustainability of the country’s HIV/AIDS program. “Malawi’s success in increasing access to antiretroviral drugs for HIV is highly dependent on donor funding for medicines,” he writes, adding, “Malawi has to actively consider its resource allocation in order to maximize the benefits and the health gained from the limited resources available.” He notes a report commissioned by UNAIDS on Malawi concluded that “unless Malawi can reduce the incidence of new infections, the scale up in access to antiretroviral drugs will not be sustainable in the medium to long term.” He concludes, “This is an important issue for the Government of Malawi, but also for the key donors who have supported the massive scale up in access to drugs, particularly the Global Fund. Malawi will need to maintain high levels of funding from the Global Fund if it is to maintain its supply of antiretroviral drugs” (10/23).
Speaking on Monday in Luanda, Angola, at the opening session of the inaugural meeting on Medical Education, sponsored by the Faculty of Medicine of Agostinho Neto University, WHO Regional Director for Africa Luis Gomes Sambo said communicable diseases account for 63 percent of deaths in Africa, with HIV and tuberculosis (TB) responsible for the majority of those, the Angola Press reports. Nonetheless, Africa has made significant progress against HIV/AIDS and malaria, as well as in improving child and maternal mortality, he said, according to the news service (10/22). Sambo also “said on Monday in Luanda that the population’s health depends on the provision of health care for those [in] need, as well as the efforts made by the society to protect, promote and re-establish the people’s well-being,” another article from Angola Press notes (10/23).
In a post in the Center for Global Health Policy’s “Science Speaks” blog, Lucica Ditiu, executive secretary of the Stop TB Partnership, examines the need to include tuberculosis (TB) in the global AIDS response blueprint that Secretary of State Hillary Clinton announced at the XIX International AIDS Conference (AIDS 2012), writing, “At present one in four AIDS-related deaths is precipitated by TB. … All people living with HIV need to get tested for TB and receive TB treatment if they have the disease.” She continues, “We urge PEPFAR to include in the blueprint explicit TB/HIV indicators and activities,” and she provides five examples (10/23).
During a meeting with UNAIDS Executive Director Michel Sidibe on Tuesday, Indonesia Minister of Health Nafsiah Mboi “pledged to scale up HIV testing and treatment programs” with a “focus on 141 districts where key affected populations are the highest,” a UNAIDS feature story reports. “Indonesia also plans to become one of several countries in the region to offer universal health care by 2014,” with HIV treatment to be covered, according to the health ministry, UNAIDS notes. Sidibe said, “Indonesia is a key partner in the drive to end the AIDS epidemic. … Universal health coverage is a game changer for Indonesia. I am delighted to know that HIV treatment will be included in this national program. This sets the stage for sustainable funding of HIV programs,” the article states. “The Ministry of Health estimates that more than 600,000 people are living with HIV and that there are more than 76,000 new HIV infections each year,” according to UNAIDS, which adds, “Currently HIV treatment coverage is at less than 20 percent” (10/23).
Oxfam Says 'No Evidence' AMFm Has Saved Lives; Global Fund Says Claims Are 'Untrue,' Guardian Reports
Noting “[t]he U.K. government has contributed Â£70 million [$112 million] to the Affordable Medicines Facility for malaria (AMFm),” the Guardian reports, “The charity Oxfam has cast doubt on [the] international scheme that aims to boost the provision of the most effective treatment for malaria.” According to the newspaper, “Oxfam says there is no evidence the program has saved the lives of the most vulnerable people” and “has criticized it as ‘risky and dangerous.'” But “[t]he body behind the AMFm says an independent study shows it has improved access and reduced drug prices,” and “[t]he Global Fund said Oxfam’s claims were ‘simply untrue,'” the Guardian writes, adding, “A DfID spokesman said: … ‘Studies have shown that quality drugs have got through to remote areas — and that more vulnerable groups, including children under five in rural areas and from the poorest backgrounds, are now being reached'” (Dreaper, 10/24).
In the Huffington Post’s “Politics” blog, Serra Sippel, president of the Center for Health and Gender Equity, notes that Secretary of State Hillary Rodham Clinton said at the XIX International AIDS Conference in July that all women should be able to decide “when and whether to have children” and that PEPFAR, in a guidance [.pdf] released last week, said, “Voluntary family planning should be part of comprehensive quality care for persons living with HIV,” and referred to family planning as a human right. “Then, in bold type, they punctuated it with, ‘PEPFAR funds may not be used to purchase family planning commodities,'” she writes. “They take it a step further with a caveat that before anyone decides they’d like their program to have anything to do with family planning, they had best consult relevant U.S. legal counsel first,” she adds. “To be fair, they do say that PEPFAR programs can just refer women to a different program that offers family planning,” but those programs are not always available, Sippel writes, adding, “So the suggestion is flawed from the start.”
The Kansas City Star examines HIV education and care in Egypt, where “the Ministry of Health says there are 2,700 cases, but the true number is estimated conservatively at more than four times that — and growing.” The newspaper writes that while “HIV education has become an international cause throughout Africa, where the rate of infection devastated many sub-Saharan nations but is being brought under control by concerted efforts on prevention and treatment,” similar efforts “are largely nonexistent in North Africa and the Middle East, and AIDS activists now worry that the rise of a conservative Islamic government in Egypt, where former longtime Muslim Brotherhood member Mohammed Morsi became the country’s first democratically elected president over the summer, will make matters worse.”
“The U.N. is leading the AIDS education effort here, and there have been efforts by individuals to bring attention to the issue,” the Star notes, adding, “According to one survey, 57 percent of doctors here think that HIV can be transmitted through a mosquito bite, according to a footnote in a U.N. report,” and “[m]any patients, unaware of the symptoms or risks, learn only by chance that they’ve been infected, when a blood test required for a visa or a medical procedure comes back positive.” The newspaper writes, “Ehab Abdel Rahman, the director of the HIV program at the Ministry of Health, balks at the suggestion that Egypt isn’t doing enough. … The blame, he said, lies with patients who try to diagnose and medicate themselves.” But “Omnia Kamal, a Morsi adviser on women’s issues and a member of the committee that’s charged with drawing up the country’s new constitution, offers a different view. In a nation plagued with economic programs and a litany of social issues, AIDS is not a priority, she said” (Youssef/Ismail, 10/22).
The Center for Global Health Policy’s “Science Speaks” blog on Friday published two posts reporting on ID Week, which concluded in San Diego on Sunday. “Wafaa El-Sadr of Columbia University offered an ID Week presentation Thursday about the impact of treatment on the global epidemic and the new promise of changing the trajectory of the epidemic by scaling up treatment both to save lives and reduce HIV incidence,” the blog writes in the first post, adding, “She reminded her audience that treatment has already had a major impact” (Lubinski, 10/19). “A trio of presentations on HIV, Women and Child Health [on Friday] morning told a story of success in preventing transmission of HIV from parents to children in the United States that has yet to be duplicated in developing countries, of options that could make a difference, and, in a look at the burdens children born with HIV will carry into adulthood, of some of the relatively rarely discussed consequences of gaps in efforts so far,” the blog writes in a second post (Barton, 10/19).
“Finding a safe, effective AIDS vaccine has, thus far, proved elusive even after some $8 billion invested from 2001-2011 into vaccine research and development,” PlusNews reports in an article examining ongoing HIV vaccine research efforts. “Scientists point to HIV’s Houdini-like ability to escape immune system attack, and less-than-strategic use of funds over the past decade, as reasons for the continued hunt,” the news service writes. PlusNews examines efforts “to seek more U.S. government funding for research that crossed over into more than one area of science. “Funding for cross-disciplinary research is still limited, said Ellen Weiss from the U.S. non-profit Biophysical Society,” the news service adds.
The UNDP on Thursday released a report, titled “Sex Work and the Law,” which “examines 48 countries in Asia and the Pacific to assess laws, legal policies and law enforcement practices that affect the human rights of sex workers and impact on the effectiveness of HIV responses,” according to a UNDP press release. “Where sex work has been decriminalized, there is a greater chance for safer sex practices through occupational health and safety standards across the industry,” the press release states, noting, “The report describes countries that use punitive law enforcement practices, confiscate condoms as evidence of illegal conduct, require compulsory or coerced HIV testing, deny government services and certain rights to sex workers, and have compulsory detention centers”; “highlights current laws, policies and practices that are helpful to HIV responses”; and “highlights how significant advances in recognition of the rights of sex workers can occur even in contexts where the sex industry is illegal” (10/18).