Category Archives: Resources

SIGN-ON! Civil Society African Common Position Paper on The International Conference on Population Development.

4. Sexual and Reproductive Health and Rights (SRHR)


4.1. General

4.1.1. Prioritize sexual and reproductive rights in health systems strengthening and development programs so that integrated, high-quality services are available, accessible, and acceptable to all people, especially women and youths, and other marginalised groups as indicated below and particularly those most underserved.

4.1.2. Protect the population’s human rights in sexual and reproductive health programs by guaranteeing that services are designed to respond to individual’s health needs and overcome barriers faced by marginalized groups, including through service provision that is free from stigma, coercion, discrimination and violence, based on full and informed consent, and that affirms the right to pleasure.

4.1.3. Programs must ensure respect for privacy and confidentiality of people in accessing services, and the capacity to make free and informed choices regarding their sexual and reproductive lives from childhood to old age in all their diversity; and pay special attention to marginalized groups.

4.1.4. These services include but are not limited to: comprehensive information on sexuality and contraception services and supplies (including emergency contraception, post exposure prophylaxis, male and female condoms); pregnancy care (antenatal and post natal care, skilled birth attendance, referral systems, and emergency obstetric care); safe abortion services and post-abortion care; access to assisted reproductive technologies; prevention, treatment, and care of sexually transmitted infections and HIV; prevention, treatment and care of reproductive cancers.

 

4.2. Safe & Legal Abortion

4.2.1. To make evidence based policy changes that recognise the cost-benefits surrounding providing women with access to safe and legal abortions on demand.

4.2.2. To immediately repeal all laws criminalizing, penalizing and/or restricting access to abortion services whilst formulating new laws and policies as a means to allow better access.

4.2.3. To specifically repeal laws that restrict young women from accessing safe abortion services on ground of requiring parental or spousal consent, age of consent or mandatory waiting periods.

4.2.4. To ensure women seeking abortion care are not subjected judicial and non-judicial persecution, including imprisonment or even harassment and degrading treatment in the health systems or by state authorities and institutions.

4.2.5. To implement right based laws and public policies that guarantee and uphold women’s access to safe abortion services without restriction.

4.2.6. To remove all non-legal and non-policy barriers to women gaining access to safe abortions on demand.

4.2.7. To ensure that healthcare workers and the health system are trained, sensitized and equipped with the necessary knowledge, equipment and resources to provide safe abortion services, including pre and post abortion services.

 

4.3. Freedom from forced sterilisation

4.3.1. Develop, promote and implement policies and clear policy guidelines with regard to sterilisation that protect the rights of women and men, including LGBTI men and women, based on a human rights framework and ensuring informed consent and free choice.

4.3.2. Monitor and document state and non-state violations around SRHR, and especially with regard to forced sterilisation.

4.3.3. Develop laws and policies that are be based on the right to health including freedom from non-consensual medical treatment or experimentation and develop laws and policies that will protect patients from non-consensual medical treatment

4.3.4. Provide on-going human rights training for health care providers, particularly in the context of forced medical treatment.

4.3.5. Establish accountability systems to monitor and ensure adherence of health care workers to human rights based laws on forced sterilisation, experimentation and non-consensual or non-informed medical treatments.

 

4.4. Accessibility, Acceptability and Affordability and Quality of SRHR services and commodities

4.4.1. Ensure the development and implementation of policy and clear policy guidelines that guarantee universal access to the provision of SRH services and commodities, with free or subsidized care for those in need and those most marginalised;

4.4.2. Inclusion and allocation of a specific SRH commodities budget within the country health budget;

4.4.3. Commit to and conduct effective monitoring and documentation of implementation strategies to minimise potential disparities and ensure universal access;

4.4.4. Support and promote an enabling environment that allows for continuous consultation, meaningful engagement and development across different and relevant sectors;

4.4.5. Commit to set up systems and structures for management, supply and timely distribution of SRH commodities so as to ensure no stock outs and no expired stock.

4.4.6. Commit to and finance the training, deployment, and retention of necessary health workers;

4.4.7. Ensure Inter and Multi-sector collaboration, learning and sharing within regional and sub-regional mechanisms of best practices and lessons learned on SRH commodity management;

4.4.8. Educate and inform citizens of their rights and responsibilities, so that they are better able to make informed decisions on their health choices, and better able to demand accessible, acceptable, affordable and quality SRHR services and commodities;

4.4.9. Recognise the role of the female condom as the only female initiated tool to prevent HIV, STI’s and unplanned pregnancies, and ensure access to quality and affordable female condoms are a reality for all women, as well as commit to funding for training and support for Female Condom Programming;

4.4.10. Recognise the need for further research into the role of anal and vaginal sexual lubricants for use as a tool to prevent HIV, STI’s and unplanned pregnancies, as well as its safety for users and compatibility with various other ingredients and condom varieties. Commit to making access to quality and affordable lubricants a reality for all people, as well as commit to funding for training and support for condom compatible lubricant use;

4.4.11. Train all health care workers, as well as procurement and head office ministry staff on new and evolving SRHR commodities especially with regard to HIV treatment and prevention technologies, this includes but is not limited to understanding the current vaginal and rectal micro-biocide and pre exposure prophylaxis fields in general and their specific programming implications for women and girls.

 

To download the full full document click here: AAI AUC Ford Civil Society African Common Position Paper on ICPD 2013 April

SIGN-ON: Civil Society African Common Position Paper on The International Conference on Population Development: 3. Population Growth and Structure

3.1. Fertility, mortality and population growth

3.1.1. Ensure that population growth and structure, and demographic work is approached with a human rights and gender responsive lens;

3.1.2. Guarantee that policies to address high fertility and rapid population growth, focus on enlarging, not restricting, individual choices and opportunities;

3.1.3. Ensure that clear policy guidelines are developed and shared and implemented so as to ensure that human rights and gender responsive lens is implemented through to clinic level and that abuse and misinterpretation is impossible.

3.1.4. Improve data collection, quality and analysis to ensure that targeted and evidence based policies are developed, implemented and then closely monitored and evaluated for necessary adjustments.

 

3.2. Demographic Dividends

3.2.1. To commit to researching, understanding, and investing in the possible dividends to be gained from the pending youth bulge;

3.2.2. To ensure that the population is able to contribute and benefit from potential gains of the demographic dividend by ensuring the following criteria are met:

3.2.2.1. Youth have universal access to quality education, including but not limited to alphabetical and numerical literacy, secondary and tertiary education, comprehensive sexuality education and citizenship and human rights education. This must be equally provided to all, without gender or geographical, religious or other discrimination.

3.2.2.2. Youth have access to programmes which provide entrepreneurship and profit-generating activities training and provided with structural support to implement business ideas;3

.2.2.3. Youth are enabled to make informed and educated decisions on their health, including sexual and reproductive health and rights, and able to access quality health services and information;

3.2.3. Reinforce universal and country specific policies with proven results to spur future job creation and economic growth.

3.2.4. Ensure accountable and transparent leadership to manage demographic change.

 

DOWNLOAD THE AFRICAN COMMON POSITION PAPER HERE: AAI AUC Ford Civil Society African Common Position Paper on ICPD 2013 April

Condom distribution in SA stops 20 000 HIV infections

A year after launching its condom distribution programme, the South African Breweries (SAB) has delivered more than 10 million condoms to taverns across South Africa, using its infrastructure, delivery trucks and extensive distribution network.

SAB launched the programme late last year as a public private partnership with the National Department of Health (NDoH), the South African Business Coalition on HIV/Aids (SABCOHA) and the Society of Family Health (SFH). SAB joined the national condom distribution programme to assist government extend its distribution reach to non-traditional outlets, namely taverns.

SAB is well positioned to undertake the task of delivering condoms owing to its efficient and reputable distribution logistics solution and extensive reach. SAB’s 40 distribution depots are used as primary distribution sites where condom stock is stored and collected by SAB truck drivers for distribution during their scheduled delivery run.

Millions of condoms distributed

The aim is to reach 16 000 local  taverns over the next five years, distributing more than 845-million condoms to these in total and averting 1.6-million new HIV/Aids infections.

To date, SAB has reached 7303 taverns and distributed 10 456 600 condoms to them over a period of a year. This has assisted in averting 20 914 new HIV/Aids infections. Taverns each received 400 condoms per month and additional stock delivered if needed. Twelve SAB depots have implementedthe programme and are operating as Primary Distribution Sites.

The HIV/Aids aversion rate is calculated according to a John Stover (founder  and president of Futures Institute) study which claims that for every 500 condoms distributed, at least one new infection is averted. This indicates that condoms are highly effective in protecting individuals against contracting HIV and sexually transmitted infections (STI’s).

“Challenges facing society are best tackled through the combined efforts of individuals and groups. Working with government and expert organisations within the HIV/Aids space, we believe that we can make a difference in the fight against the pandemic which has a devastating impact on communities and economic development,” says Hepsy Mkhungo, SAB Head Enterprise Development and Community Partnerships.

 

8 November 2012

Press Release November 2012

By Health 24

http://www.health24.com/news/HIV_AIDS/1-920,77742.asp

HEALTH: Uneven progress in global TB fight

NAIROBI (PlusNews) – The UN Millennium Development Goal (MDG) target of halting and reversing the tuberculosis (TB) epidemic by 2015 has been achieved, and the world is on track to meet the target of reducing global TB prevalence by 50 percent by 2015. But the progress has been irregular, with Africa and Europe lagging behind the rest of the world, according to the new Global Tuberculosis report by the UN World Health Organization (WHO).

“In the space of 17 years, 51 million people have been successfully treated and cared for… Without that treatment, 20 million people would have died,” Mario Raviglione, director of the WHO Stop TB Department, said in a statement.

Threats to progress

The report highlights successes in rolling-out a rapid TB diagnostic test, as well as the successful implementation of collaborative HIV and TB activities. Globally, 40 percent of TB patients had a documented HIV test result, and 79 percent of HIV-positive people received co-trimoxazole, an antibiotic preventive therapy, in 2011. Additionally, progress continues to be seen in the development of new medical interventions.

However, the report also took note of several issues threatening progress in the fight against TB: In 2011, there were an estimated 8.7 million new TB cases and 1.4 million deaths, 430,000 of which were among people co-infected with HIV. In addition, a US$1.4 billion funding gap for research and a shortfall of $3 billion per year for TB control and care between 2013 and 2015 “could have severe consequences for TB control”.

Africa and Asia continue to bear the highest burden of the diseases, with India and China accounting for nearly 40 percent of the world’s TB cases. Close to 80 percent of TB cases among people living with HIV are in Africa. Although the report found reduced rates of infection and deaths overall, Africa and Europe are not on track to halve 1990 levels of mortality by 2015.

Of particular concern is the slow progress of the response to multi-drug resistant (MDR)-TB. The report estimates that 3.7 percent of new cases and 20 percent of previously treated cases were estimated to have MDR-TB.

Funds needed

In Uganda – which is on WHO’s list of high-burden countries that, together, are responsible for more than 80 percent of the global disease burden – the Ministry of Health says it urgently needs money if it is to succeed in reversing the spread of TB.

“The funds are not enough. The costs for drugs, trainings, food for patients, treatment follow-up, delivery of drugs to the patients, monitoring the patients and supervision are exorbitant,” said Samuel Kasozi, MDR-TB coordinator in the Ministry of Health. “The management of MDR-TB and TB cases requires enough finances. We are supposed to follow and monitor these patients. But we have serious financial constraints.”

The country recently started its first treatment programme for MDR-TB, and has so far enrolled 30 people. While it has purchased drugs for 300 patients, infrastructural and financial issues have so far prevented more patients from starting the treatment. The ministry requires $625,500 for constructing an isolation ward at each hospital, $4,000 per patient for two years of treatment, $400 per patient for laboratory reagents, $500 per month for each patient’s food and $7,000 per site for training health workers.

“Most health facilities have inadequate human resources. Some of them don’t have both the number and quality of personnel to handle the patients. MDR [TB] treatment requires skilled and qualified doctors, medical officers, nurses, counsellors, laboratory technicians and mental experts to handle the side effects of the drugs,” Kasozi added. “The laboratory equipment to monitor patients is weak. Before you put someone on treatment, you need to do some tests like culture and drug acceptability, kidneys and liver. The gadgets are available but the reagents are missing.”

WHO is calling for “targeted international donor funding and continued investments by countries themselves to safeguard recent gains and ensure continued progress”.

By Plus News

7 November 2012

http://plusnews.org/Report/96576/HEALTH-Uneven-progress-in-global-TB-fight

SOUTH AFRICA: Easy patents cost patients

Drug Prices Still High

JOHANNESBURG, 5 November 2012 (PlusNews) – South Africa grants almost every patent application it receives, making its patent regime one of the world’s most lenient. While pharmaceutical companies cash in, patients face staggering healthcare costs, and medicines like cancer treatments, third-line antiretrovirals (ARVs) and treatments for drug-resistant tuberculosis (DR-TB) are often priced out of reach.

A form of intellectual property protection, patents are typically awarded to companies that can prove their product is new. Not so in South Africa, say activists and researchers, who claim the country’s patent system allows pharmaceutical companies to apply for new patents on existing drugs based on immaterial changes – like adding table salt to a formulation or changing a pill’s colour.

According to activists from Médecins Sans Frontières’s (MSF) Campaign for Access to Essential Medicines and the South Africa AIDS lobby group the Treatment Action Campaign (TAC), easy patents mean companies can extend their exclusive right to manufacture and sell certain drugs, a process known as evergreening.

With competition eliminated, drug prices stay high – often out of reach of South African patients, activists argue.

Substantial costs

In South Africa, third-line ARVs – all under patent – costs about US$4,000 per patient per year in private-sector health facilities. This high cost means patients in need of these medicines, which are considered drugs of last resort, often go without. The medicines aren’t offered by public health facilities, according to MSF and TAC.

Additionally, the country diagnoses about 45,000 cases of multidrug-resistant TB (MDR-TB) annually, but one of the few drugs available to treat MDR-TB, linezolid, costs about $2,500 per month of treatment because of patent protection. Linezolid is also not available from public sector healthcare providers.

While its patent expires in 2014, a patent on a crystallized form of the drug may block generics from entering the South African market until 2022. An Indian generic, currently restricted because of linezolid’s patent, costs about $70 per month.

The country is preparing a new draft policy on intellectual property, so now is the time to fix the patent laws that allow for these high prices, said Vuyiseka Dubula, TAC’s secretary general.

“In the past 13 years, we have been fighting [patents] drug by drug. Today is about fixing the problem once and for all, to deal with our issues and ensure access to ARVs and DR-TB drugs,” Dubula told IRIN/PlusNews. “I’m saying this as a person openly living with HIV who is alive today because of access to affordable medicines.”

Patent reform will likely have implications for the government’s efforts to initiate local ARV production and implement national health insurance – policy decisions announced by the National Department of Health. The health department has little control over the country’s new intellectual patent policy, which is largely the domain of the Department of Trade and Industry (DTI).

Easy come, easy go?

How easy is it to get a patent in South Africa? The Mailman School of Public Health, at Columbia University in the US, examined about 2,400 patent applications filed with European Union, US and South African patent regulators between 2000 and 2002. While European and American officials approved about 60 percent of these applications, South African patent administrators approved almost every application submitted, according to the study’s preliminary findings, which were recently presented in Johannesburg by associate professor Bhaven Sampat.

A study by South Africa’s University of Pretoria found that 80 percent of patents in South Africa would not have been granted if the country actually scrutinized patent applications. Study authors also found that country’s patent laws did not widely support local innovation, but instead facilitated exploitation by foreign companies and created substantial social costs.

The most recent review of South African patents, conducted in 2008 by Yousuf Vawdaw, a professor of law at South Africa’s University of KwaZulu-Natal, found that about half of all South African patents that year were granted to US companies, followed by companies from the UK, Germany and France.

New policy to be released in December

The DTI’s draft of the new intellectual property policy is set to be submitted to the cabinet on 5 December. A three-month period of public comment on the policy will then be opened before the policy becomes a bill, according to MacDonald Netshitenzhe, the department’s chief director of policy and legislation.

Despite calls from organizations such as TAC and MSF, the draft policy has not yet been made public, but Netshitenzhe says provisions to oppose patents are in the draft policy. Vawdaw and other experts say they hope the policy includes provisions to dissuade evergreening and to allow for compulsory licences.

When the World Trade Organization (WTO) was created, it introduced standards to protect intellectual rights through its Agreement on Trade-Related Aspects of Intellectual Property Rights (TRIPS). Aware that the protection of intellectual property rights might hinder access to public health resources such as generic medicines, the WTO, in 2001, reaffirmed governments’ right to use TRIPS’s built-in flexibilities to increase access to public health resources such as essential medicines.

Compulsory licences are one of the most commonly used TRIPS flexibilities. When it is in the national interest, governments in countries with insufficient pharmaceutical manufacturing capacity can authorize the use of a patent-protected invention without the consent of the patent-holder. Patent holders are then compensated, usually in the form of royalties.

Although historically opposed to compulsory licenses, the US issued one for the drug Ciprofloxacin, an antibiotic used to treat anthrax, in the wake of the September 11 attack. But DTI’s Andre Kudlinski has argued compulsory licenses are unnecessary when large pharmaceutical companies like Aspen have received voluntary licenses on ARVs in the past.

The ‘BRICS’ group of advanced emerging countries – Brazil, Russia, India, China and South Africa – is coming under increased pressure to impose stricter patent laws, particularly through fair trade agreements, and Leena Menghaney, head of MSF’s Access Campaign in India, warns that the choices South Africa makes now may set the tone for discussions in countries like Brazil and India.

By PLusNews

6 November 2012

http://www.plusnews.org/Report/96712/SOUTH-AFRICA-Easy-patents-cost-patients

SOUTH AFRICA: Revamped AIDS council makes its debut

JOHANNESBURG, 9 October 2012 (PlusNews) – After a troubled past, a revamped South African National AIDS Council (SANAC) was recently unveiled, coinciding with the announcement that the country has achieved universal access to HIV treatment. South Africa must now ramp-up prevention, new SANAC CEO Fareed Abdullah said.

The newly reformed body is now undergoing a wide range of initiatives to improve its effectiveness and the country’s HIV prevention efforts, including increasing national funding for prevention activities, reinvigorating provincial AIDS councils and broadening representation within the body’s leadership.

In 2010, SANAC released a mid-term review of the country’s national strategic plan on HIV, which found that the national AIDS body was not user-friendly, failed to coordinate provincial HIV responses, and faced shortcomings in provincial monitoring and evaluation. The report proposed a new SANAC structure to make it “fit for purpose”.

Responding to these recommendations, and to criticism by civil society, SANAC was reformed over the last 18 months. The body will now hold a new, annual meeting comprised of representatives from the research community, labour unions and people living with HIV. At this meeting, participants will discuss major policy issues and review progress on the country’s current national plan to address the twin epidemics of HIV and tuberculosis.

SANAC leaders, representing diverse groups including women, sex workers and businesses, approved the restructuring on 17 August 2012. New leaders, following nomination and selection, will undergo an orientation at the end of October, according to South African Deputy President Kgalema Motlanthe, who, as deputy president, chairs the body.

The body recently held the inaugural session of this plenary body in Pietermaritzburg, the capital of South Africa’s KwaZulu-Natal province, which Motlanthe has described as the epicentre of the country’s HIV epidemic.

Treatment grows as prevention lags

At the meeting, SANAC announced new figures showing that two million South Africans are now on antiretrovirals; this figure covers about 80 percent of those estimated to need treatment in the country, surpassing the country’s 2006 universal access target, according to a UNAIDS report.

The country funds about 80 percent of its HIV response domestically, and about 70 percent of this is earmarked for treatment – leaving less than 20 percent for prevention. In the first quarter of 2012, the country only met about 30 percent of its condom distribution target, handing out 84 million condoms – about one condom per month for each of South Africa’s estimated 24 million males.

According to CEO Abdullah, SANAC has begun negotiating with the treasury department to try to allocate more money towards prevention.

Resurrecting provincial AIDS councils?

Provincial AIDS councils have been historically ineffective, but SANAC will be helping to strengthen these, Motlanthe said in a statement.

“Each province has unique economic, social, infrastructural and cultural characteristics. There are population dynamics, health and community systems, and human resource issues that determine the impact of programmes, thus requiring context-specific approaches… for success,” he said. “This underpins the importance of having functional and efficient Provincial Councils on AIDS to better monitor the provincial responses.”

According to Abdullah, SANAC will now be providing resources to provincial AIDS councils and has been advocating for high-level politicians to join these groups. Already, KwaZulu-Natal Premier Zweli Mkhize has begun taking an active role in his province’s council, drawing the attention of several other premiers, Abdullah told IRIN/PlusNews.

By IRIN Plus News

9 October 2012

http://www.plusnews.org/Report/96492/SOUTH-AFRICA-Revamped-AIDS-council-makes-its-debut

The Online Survey. The New Working Paper From AIDS Accountability International.

The AIDS Accountability International online survey began in April 2012 and captured responses from twenty respondents in the following two months. Interestingly we had an additional ten respondents from beyond SADC which may inform our future work, if this indicates a need in regions beyond SADC.
The survey contained thirty-five questions overall but most were targeted based on the CCM membership status of the respondents so respondents on average answered only nineteen questions. The survey was designed to interrogate the level of involvement of marginalized people in the Global Fund Country Coordinating Mechanisms in the SADC region. Although the number of respondents is small, AAI suggests that this information, in conjunction with the in-depth interviews, is reflective of the current challenges being faced with regard to participation and representation of women, girls and LGBT people on Southern African CCMs.

HIV, TB or Malaria

Although all of the respondents were from the HIV/AIDS area of work (n=20), twelve respondents also worked in either TB, malaria, or SRHR including gender based violence. Two respondents indicated that they represent “the private sector” and “substance abuse” areas of work.

CCM member

Seventy percent (n=14) of the respondents were currently members of their national Country
Coordinating Mechanism. Of these CCM members the average number of months already served was twenty-four months. Five of the CCM members were recipients at some level of GFATM grants. Three respondents represented UN agencies, and the private sector and religious institutions were also represented.

Representation

Which of the following groups of people does your organization represent? versus Which of the following groups of people do you represent on the Country Coordinating Mechanism?

Most groups represent more than one group of people, and this is reflected in the numbers above. Only 7 of the 14 CCM members answered this question. However, when comparing the two graphs a worrying finding presents itself, as girls and LGBT people are under-represented by their respective organizations on the CCM. This is a worrying finding as it indicates that representation on CCMs does not necessarily reflect the target group of an organization. This is further highlighted in the graphs below that interrogate the quality of representation by group.

Quality of representation – Evaluation of CCMs by members versus non-members by group of people

Please evaluate the current level of participation of these groups in the Country Coordinating Mechanism.

CCM Members
Non-members of CCMs.

The first graph supports the findings in the qualitative interview section of this report: that most respondents suggested that women on CCMs were keen participators and were well represented on their CCMs. Interestingly it appears that CCM members demonstrate more extreme judgments of representation on the CCMs than non-members. 40.5% of members marked totally unacceptable versus 33% of non-members, the other extreme 5.2% of members marked perfect representation versus 2% of non-members. Thus it seems that outside perceptions of CCM inclusion of marginalized groups is less critical than internal perceptions. In other words, people outside the CCM perceive representation of the marginalized to be better than it really is. This could mean that civil society needs to better engage with CCMs if they do not yet realize how problematic the issues actually are.

However, what is telling is that 76% of non-members marked one of the below acceptable options whilst only 63% of CCM members marked representation as unacceptable in these categories. This would show that overall non-members are less satisfied with the quality of representation.
What is encouraging is that there is a sense that women and people living with HIV/AIDS are currently represented at fairly satisfactory levels. The data by no means suggest that this representation is completely perfect in quality, and indeed it suggests that some work still needs to be done, however comparatively to girls and LGBT people there is a greater level of satisfaction with performance in this area.

Evaluation of current CCM in respondent’s country (various issues)

Non-members

Please rate the current CCM in your country in terms of:

The above graph demonstrates the responses that non-members gave when asked about the effectiveness of CCMs in their country. Again we see a lack of accountability to girls and LGBT people reflected in the lack of participation of these groups. In a region where issues such a child brides continues to exist, and where sexual and reproductive health and rights for girls and LGBT are limited, there needs to be the acknowledgement from all stakeholders for the now urgent inclusion and meaningful participation of these two groups. Each CCM should actively seek to invite a new member that is outspoken, informed and representative of each of these two groups in order to address this lack. The GE and SOGI strategies were created as a means to improve these scenarios and as yet seem to be lacking in impact as the section below demonstrates but pro-active decisions to include these groups can begin to rectify this troubling problem.

Evaluation CCM members experience working with the CCM

Members

Please tell us about your experience of working with the CCM, by marking the most accurate option. I am…

Interestingly the responses to the above options are not unexpected. All stakeholders are aware of the limitations of being able to be fully heard in meetings and committees of this sort. Adequate and meaningful participation and involvement includes not only being able to attend meetings, but being able to prepare, create input and then share and discuss openly and fully and thus properly influence the issues that affect girls and LGBT. Barriers to meaningful participation often include financial constraints, logistical issues, language choices and fluency, capacity to engage with content and the “softer” issues such as confidence, respect and time management in terms of speaking out. CCMs should work to improve the issues to the right of the above graph, and actively begin to take steps to improve this unhelpful situation.

Evaluation of CCM members’ knowledge of the various GFATM strategies affecting GE and SOGI


(**Implementation Plan of GE Strategy. In the questionnaire each option was fully written out in the questionnaire to assist respondents as much as possible).
This amounts to 62% of respondents (who are CCM members) who answered “No” or “Don’t know”, leaving just 38% who are familiar with the above GFATM strategies and technical advisors.
In a similar vein, CCM members were asked the following questions:
“Have you contacted the Global Fund Advisors for any technical support?” 86% answered “No” and only 14% “Yes”, whereas to the question “Have the Global Fund Advisors contacted you to offer any technical support?” the figures were marginally better but still unacceptable at 71% responding “No” and only 29% responding “Yes”.
When asked what their CCM was doing to implement the GE and SOGI strategy, one respondent noted that “[There has been] a positive move though we need to do more”, another stated “We are implementing Gender Equality as per our National Strategic Framework and not based on Global Fund’s one”, and a third “By taking deliberate inclusion of all gender”, all other answers either noted that they were not aware of the strategies or that nothing was being done (n=9).

Evaluation of the Global Fund’s guidelines’ and policies’ impact on improving the
following issues

Two respondents mentioned that the GFATM had had an impact on “Multisectoral Management of HIV/AIDS services” and another that “Although I am not aware of any strategy regarding sexual minorities at the level of the CCM, it is a fact that the issue of discrimination in relation with the LGBT communities has been taken on board in our National Strategic Framework.”
None of the CCM members marked that the strategies had made any negative impact, but 57% did mark that the strategies had made “No impact”, mostly significantly on gender inequality. Only 29% said that the strategies had made “Some positive impact” on gender inequality. No respondents said that the strategies had made “Very positive impact” on any of the four areas requiring improvement.

On Clinton trip, Uganda and Malawi offer opposite lessons for AIDS in Africa

Clinton In Africa

LILONGWE, MALAWI — If this small nation, with a per capita income of less than $3 a day and a life expectancy of 53, offers a hopeful model for fighting the scourge of AIDS in Africa, then large and relatively prosperous Uganda shows how quickly progress can run off track.

Secretary of State Hillary Rodham Clinton saw Malawi’s more promising example Sunday as part of an eight-nation African visit. Last week in Uganda, she highlighted an alarming rise in infection rates there after years when the country was a leader in preventing the spread of HIV and AIDS. About 23 million people in sub-Saharan Africa are believed infected, and the United Nations has estimated that the region had 1.2 million AIDS-related deaths in 2010.

“I am here because I am worried,” Clinton said Friday during a tour of a health center near the Ugandan capital, Kampala, that treats women with HIV and AIDS.

“In recent years, the focus on prevention has faded, and new infections are on the rise again,” she said. “Uganda is now the only country in sub-Saharan Africa where the rate is going up instead of down.”

The number of Ugandans with HIV doubled between 2004 and 2011, from 1.2 million to 2.4 million. A more blase attitude about AIDS among Ugandans is one explanation, and a more socially and religiously conservative approach to the epidemic from the government of Yoweri Museveni may be another.

By contrast, Malawi has a higher infection rate but a more progressive approach to countering it. Clinton said little about the epidemic during a one-day visit here Sunday. But her very presence as the first U.S. secretary of state to visit Malawi was a mark of regard for the new government of President Joyce Banda, a women’s rights activist who has backed aggressive HIV-prevention programs.

Clinton toured an educational summer camp for girls run by the Peace Corps, where the curriculum includes sexual health and birth control. Later, Clinton’s party bumped down a long dirt track to a U.S.-sponsored milk-production cooperative where farmers can also be tested and treated for HIV.

U.S. officials say about one in 10 Malawians is infected with HIV or has AIDS, a crippling figure. But the rate has fallen from 13 percent over five years, and innovative prevention and treatment programs extend through much of the country. Malawi has cut mother-to-child transmission of the virus, condom use is widely accepted, and a male circumcision program once unthinkable in this traditional society is now oversubscribed.

U.S. officials point to a huge change in public attitudes and awareness over the past decade. In 2002, Malawi suffered the worst famine in 50 years, caused in part by the absence of farmers who were too sick to work or who were caring for sick relatives.

“The government is committed,” said Ritu Singh, who heads HIV and AIDS work in Malawi for USAID. “They understand this is a problem, and they understand this is affecting their people.”

The challenges remain vast, even leaving aside Malawi’s poverty. Per capita income is about $900, more than half the population is dependent on outside aid, and U.S. donations fund the majority of Malawi’s annual health budget.

 

By Anne Gearan

6 August 2012

http://www.washingtonpost.com/world/national-security/on-clinton-trip-uganda-and-malawi-offer-opposite-lessons-for-aids-in-africa/2012/08/05/c717c072-df30-11e1-8d48-2b1243f34c85_story.html

In Uganda, an AIDS Success Story Comes Undone

KAMPALA, Uganda — Uganda’s sharp reduction of its AIDS rate has long been hailed as a Cinderella success story, inspiring a wave of aid programs and public health strategies to fight the disease across the developing world.

But as Secretary of State Hillary Rodham Clinton arrived here on Thursday, the news on AIDS in Uganda was not so bright: A new American-financed survey says that Uganda is one of only two African countries, along with Chad, where AIDS rates are on the rise.

The reversal is particularly disappointing to health experts given the time and attention that have been focused on AIDS here, and the billions of dollars spent.

Nearly a third of Uganda’s population in some areas had once been infected with AIDS or the virus that causes it. An aggressive public awareness campaign that urged medical treatment and monogamous sexual relationships led to a precipitous drop in infection rates in the 1990s.

But the coming survey said that H.I.V. infection rates in Uganda have increased to 7.3 percent today from 6.4 percent in 2005. Over roughly the same period, the United States, through its AIDS prevention strategy known as Pepfar, or the President’s Emergency Plan for AIDS Relief, spent $1.7 billion in Uganda to fight AIDS.

The report, the Uganda AIDS Indicator Survey, detailed the health status and sexual behavior of more than 20,000 Ugandans across the country. The results raise questions about the effectiveness of the United States’ AIDS-prevention strategy here.

H.I.V. and AIDS rates in Uganda are increasing not only in urban areas, but rural areas too, the survey shows. Adult husbands and wives, not youths or commercial sex workers, are the ones spreading the disease, according to the survey. By their late 30s, roughly one in 10 women now become H.I.V. positive. For men, roughly one in 10 are infected by their early 40s.

For both men and women, the survey shows, H.I.V. prevalence increases, rather than decreases, with wealth.

Health experts blamed Uganda’s government for becoming complacent since winning international acclaim, and reams of financial aid, for its AIDS efforts. But the survey suggests that development strategists have long misunderstood the nature of Uganda’s H.I.V. epidemic, as well.

“Something is not connecting properly,” said Dr. Musa Bungudu, the United Nations’ AIDS chief in Uganda. “There are a lot of sociocultural issues that need to be addressed. These are harsh realities.”

Uganda’s early success in battling H.I.V. included grass-roots behavioral change campaigns aimed at reducing the number of sexual partners among Ugandans. The United States shifted its policy in 2003, teaming up with faith-based organizations and adopting Pepfar’s emphasis on abstinence, monogamy and using condoms “for those most at risk.”

Billboards promoting that approach can be seen all over the capital, and the Pepfar-sponsored message — “Get Off the Sexual Network” — is published in YouTube videos and on radio.

But there has been a miscalculation: the strategy may have merely succeeded in driving certain behaviors further underground in this socially conservative country with close ties to American evangelicals.

On one hand, 90 percent of Ugandans today acknowledge sexual fidelity in a relationship as a health imperative, according to the survey results; on the other hand, roughly 25 percent of married men said they had multiple sexual partners.

The survey found that 75 percent of Ugandans were knowledgeable about condoms in sexual health but that fewer than 8 percent of married men who were having sex outside their marriage were using condoms.

Uganda’s hard-line approach toward homosexuality, which is outlawed here, also fuels the spread of AIDS, experts say. One report indicated that one-third of the male respondents who had sex with other men said they had previously been married to women and fathered children. Fewer than half use condoms.

Pepfar’s founding policies barred partnering with organizations that did not condemn prostitution, and called for 33 percent of financing to be spent on abstinence and fidelity programs.

“We have messages confusing what is right with what is safe,” says Canon Gideon Byamugisha, a religious leader and AIDS activist in Uganda. “If you have an environment that stigmatizes them, then don’t expect people to use condoms.”

Some argue that Uganda’s initial AIDS-prevention success was based on the extreme fear that the disease generated among the population.

“A lot of people saw a lot of friends and co-workers die from H.I.V.,” says Shanti Parikh, a medical anthropologist studying sexuality at Washington University in St. Louis who studies Uganda. The effect of risky sexual behavior was “very open and upfront.”

Over time, experts said, medical treatment grew more effective and less expensive and the panic faded.

The huge inflow of foreign development aid also led to corruption and prompted the government, which contributes roughly one-tenth of its AIDS budget, to rely on outside financing. “They need to go back to square one,” said Dr. Bungudu, the United Nations official.

Dr. Christine Ondoa, Uganda’s minister of health, said in a statement that the results indicating AIDS remains “a significant health problem” here presented the government with an “an opportunity to recommit ourselves.”
A version of this article appeared in print on August 3, 2012, on page A5 of the National edition with the headline: In Uganda, an AIDS Success Story Comes Undone.

By JOSH KRON
Published:  2 August 2012

http://www.nytimes.com/2012/08/03/world/africa/in-uganda-an-aids-success-story-comes-undone.html?_r=1

AIDS conference marks turning points in fight against epidemic

19th International AIDS Conference

WASHINGTON, D.C. — The 19th International AIDS Conference ended July 27 on an optimistic note, with speakers presenting a vision of an “AIDS-free generation,” despite the myriad economic, social and scientific barriers that remain. And for the first time, scientists dared to talk seriously about an AIDS “cure,” an admittedly daunting technical challenge.

“We are at a defining moment,” said Diane Havlir, MD, conference co-chair and professor of medicine at UC-San Francisco. “It would be an extraordinary failure of global will and conscience if financial constraints truncated our ability to end AIDS just when the science is showing us this goal is achievable.”

Some 24,000 people from 183 countries attended the biannual gathering, held this year in Washington, D.C. Always a colorful, cacophonous event, this year’s conference featured more than its share of public policy discussion, with presentations by Secretary of State Hillary Clinton, Sens. John Kerry, D-Mass., and Lindsey Graham, R-S.C., and Rep. Barbara Lee, D-Oakland.

The world is gaining ground against AIDS, with more people now on treatment (8 million) than those who need it (7 million), said Michel Sidibe, executive director of the Joint United Nations Program on HIV/AIDS, also known as UNAIDS. Worldwide infections have declined 20 percent since 2011, and in hard-hit Africa, AIDS-related deaths have fallen from 1.8 million in 2005 to 1.2 million today, he said.
Still, there are 34 million people living today with HIV, and for every person on treatment, two more become infected, highlighting the need for stepped-up prevention efforts, speakers said. And though 100,000 fewer babies were born HIV-positive in 2010, there were still some 330,000 infants who became infected at birth or through breastfeeding in 2011. Clinton, who announced an $80 million initiative to prevent mother-to-child transmission, said the goal is to reduce this number to zero by 2015.

The advancing science of AIDS, meanwhile, has produced a plethora of new treatments and prevention strategies that could help drive down AIDS prevalence. These include voluntary male circumcision, use of anti-AIDS drugs in infected individuals to reduce their chance of passing on the virus to others, as well as use of these drugs as preventives in uninfected people.

Yet it is unclear how all of these strategies will be implemented and whether funds will become available to put them into action.

“There is the thinking that we can bend the curve downward in a substantive way, but money is flat, which creates some very obvious tension,” Eran Bendavid, MD, assistant professor of medicine at Stanford, said in an interview at the conference.

AIDS funding has remained constant since 2008 and, with the decline in contributions from some of the wealthier nations, there remains at least a $7 billion gap in funding to achieve universal access to HIV prevention, treatment, care and support by 2015 — a major UNAIDS goal, Sidibe said. The perennial issue of funding shortages sparked a number of demonstrations during the conference, including a march on the White House by protesters calling for lower-cost AIDS drugs and more resources.

This is the first time in 22 years that the conference has been held in the United States, putting the spotlight on the domestic epidemic, which continues out of control. An estimated 1.2 million Americans are believed to be infected with the virus, and 20 percent don’t even know it, said Anthony Fauci, MD, director of the National Institute of Allergy and Infectious Diseases. Each year, 50,000 more are added to the ranks of infected people. Moreover, only 28 percent of those infected are linked to care and stick with it long enough to bring the disease under control, he said.

“In the richest nation on the planet, barely a quarter (of those infected) are on effective treatment,” said Phil Wilson, president and CEO of the Black AIDS Institute. “That is bad for them and bad for the rest of us. Because if they are not on treatment, they are much more likely to spread the virus.”

Mark Holodniy, MD, professor of medicine at Stanford, said he sees this problem among the 200 HIV patients at the Palo Alto Veterans Affairs Health Care System. Many don’t take their medications for a variety of reasons — mental health problems, substance abuse, incarceration, multiple medical issues or simply because they can’t get to a clinic, he said. The VA is one of the largest HIV providers in the United States, with 25,000 patients at 152 sites.

“HIV in the veteran population is a big problem, and we’re constantly trying to improve access and services. We have a ways to go,” Holodniy said. “If we can figure it out here, we can export it to Africa” and other areas of high prevalence.

Holodniy said it’s unclear how some of the new AIDS-fighting technologies will be implemented locally. For instance, the U.S. Food and Drug Administration recently approved the antiretroviral drug Truvada as a form of prevention in uninfected people, as studies have shown it can reduce risk of infection by as much as 72 percent when taken conscientiously by the uninfected person.

“The studies are compelling that it has significant impact on reducing infection,” he said. “But there are costs, and there are toxicities.”

Because the drug is expensive — almost $10,000 a year — it would only be cost-effective to use it in select, high-risk groups, according to a study published in April by Bendavid. So issues remain about who will pay, as well as how to target appropriate groups and ensure that those taking the drug continue to follow safe sex practices and be monitored for side effects. “There are a lot of questions about how it will work in the real world,” Bendavid said.

In other scientific developments, researchers unveiled a new effort, involving a team of scientists from around the world, to find an AIDS cure. What makes HIV eradication so challenging is the fact that the virus integrates itself into the DNA of specialized immune system cells and can persist there indefinitely without detection. Scientists are just starting to develop tests to measure these latent cells not only in the blood, but in other body tissues, such as the lymph nodes or genital tract, where they may be hiding, said Javier Martinez-Picado, PhD, a senior investigator at IrsiCaixa AIDS Research Institute in Barcelona.

David Margolis MD, of the University of North Carolina-Chapel Hill, reported some success in the use of the cancer drug Vorinostat to lure the cells out of hiding. In theory, antiretrovirals then could be used to mop them up.

“Certainly, this is promising,” Martinez-Picado said.

Still, scientists cautioned that the technical obstacles to a cure could be insurmountable.

“Getting something into the lymph nodes, liver and brain, homing in on those cells and destroying those cells is a bit of a tall order,” Holodniy said.

BY RUTHANN RICHTER

31 July 2012

http://med.stanford.edu/ism/2012/july/aids-conf-0731.html