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Africa: Staying the Course on AIDS?

AfricaFocus Bulletin
Mar 15, 2010 (100315)
(Reposted from sources cited below)

Editor's Note

We must end the false dichotomy between prevention and treatment. If we choose one over the other we will fail. We know from our experiences in the 1990s, that if treatment isnt there, people will not come to the health centers and doctors and nurses will not stay. We know from our long experience that it is virtually impossible to have successful public sector health and AIDS treatment programs where some people get therapy and others in dire need dont. - Dr. Peter Mugyenyi, Joint Clinical Research Centre, Kampala

Despite substantial successes, and new evidence that universal access to treatment could make a sufficient contribution to prevention to roll back the pandemic, the commitment to universal access this year will clearly not be met.

Testimony to Congress, international meetings, and progress reports released by the Global Fund to Fight AIDS, TB and Malaria this month stress that critical decisions are coming up this year on whether world leaders will continue the momentum in the fight against AIDS. Only one-third of people in need of HIV treatment worldwide receive it, while more than 10 million more people in urgent need of life-saving HIV treatment wait. South Africa in particular has made significant new commitments to expand treatment, but among rich countries the political will to follow through on commitments is problematic.

This AfricaFocus Bulletin contains the testimony to Congress by Dr. Peter Mugyenyi, a press release from the International AIDS Society on a meeting of AIDS activists and experts with U.K. International Development Minister Gareth Thomas, and a press release on the latest progress reports released by the Global Fund to fight AIDS, TB and Malaria.

For previous AfricaFocus Bulletins on health issues, visit http://www.africafocus.org/healthexp.php

++++++++++++++++++++++end editor's note+++++++++++++++++++++++

Testimony to Congress: House Committee on Foreign Affairs, Subcommittee on Africa and Global Health. Thursday, March 11, 2010.

Peter N. Mugyenyi M.D.

Executive Director of Joint Clinical Research Centre, Kampala, Uganda.

Thank you Chairman Payne and Ranking Member Smith for giving me the opportunity to address this committee, whose work has created and sustained the US global AIDS response.

PEPFAR has saved millions of lives in Africa. PEPFAR started at a time when the AIDS crisis in Sub-Saharan Africa had reached a catastrophic stage because timely action was not taken, and the African countries were too overwhelmed by the sheer magnitude of the disaster. Before PEPFAR, less than 100,000 thousand in Africa had access to life saving antiretroviral drugs, and millions were dying from what had become preventable deaths in rich countries. Today, there are four million people on ARV treatment in low- and middle-income countries. These people and their mothers, husbands, wives and children got a chance to livemore than half of whom have benefited from the U.S. governments contributions to PEPFAR and the Global Fund.

Beyond treatment, support for care and prevention efforts has helped ease the carnage that I and my fellow health care providers used to witness on a daily basis. It has been replaced by hope.

Recent evidence has shown that HIV programswhere they have reached community-wide coverage--have been among the most effective interventions having impact well beyond the AIDS epidemic.

Studies in Uganda have shown the increase in services for HIV/AIDS was accompanied by a reduction in non-HIV infant mortality of 83% as parents not only lived but thrived. The DART study, which I co-chaired, found a 75% reduction in Malaria associated with anti-retroviral therapy.

These programs have also strengthened our health system beyond addressing HIV/AIDS. For instance, PEPFAR assisted my Institution, the JCRC, to build the 7 laboratories that support nearly all of the public clinics and train several thousand health care providers now providing crucial services to both the public and private sectors in Uganda.

This success has been coupled with real excitement at new evidence that reaching all those in need of ARVs could help us stop new infections and beat the epidemic for good. New data from Conference on Retroviruses only a week ago, which I attended in San Francisco, shows that HIV transmission between heterosexual couples in Africa is reduced by 90% if the HIV-positive partner is on antiretroviral therapy. This gives credence to recent modelling by the World Health Organization that shows some of the first good news on prevention in several years: that we could truly end the AIDS crisis within a generation.

Today, however, a funding crisis threatens to reverse these highly positive changes and we could miss the opportunity to defeat the epidemic.

AIDS in much of Africa is still an emergency. It continues to be the biggest killer of women of reproductive age in Africa. In Uganda, we have come very farbut were less than half way there. Only 170,000 adults out of estimated 350,000 in immediate need of life-saving ART, and 12,000 children out of estimated 60,000 who need treatment, are receiving it now.

Unfortunately, over the last two years, PEPFAR funding has flat-lined. New PEPFAR contract awards emphasize treatment for only those already on it and only very limited slots for new patients

Currently, my institution, which pioneered antiretroviral therapy in Africa and treats a large proportion of AIDS patients in Uganda, is not taking new patients due to lack of funding. We are forced to turn away desperate patients dailyoften 15 to 20. And most of those who come to us will have been turned away from a number of other clinics.

When I say new patients, it is important to note that most of these are not truly new. Thousands of Ugandans (and millions throughout Africa) heard the messages from PEPFAR-funded programs that knowing your HIV status was important to protect yourself and others, and that treatment would be available to those that require treatment. Even though we have put thousands of patients on PEPFAR-supported care.today, my program and numerous others across my country cannot deliver on the promise of treatment.

I have witnessed many desperate patients unable to access therapy, including pregnant women, resorting to desperate and dangerous measures including sharing drugs with their family members, ignoring the good counselling they receive advising against this dangerous practice.

Recently, an HIV-infected woman who was breastfeeding her HIV-negative child because she could not afford formula milk came to our clinic, having been turned away from three other clinics in Kampala because they had no slots. She knew that every day she breast fed her baby without being on treatment greatly increased the chances of her child getting infected, but she had no alternative.

We at JCRC in Uganda led the early resistance testing studies which found that treatment interruptionincluding sharing of drugs which is becoming increasingly widespreadresult in drug resistance. This will result in large numbers of patients failing on the simpler and low-cost first-line drugs and needing more expensive and more sophisticated second-line therapy.

We must end the false dichotomy between prevention and treatment. If we choose one over the other we will fail. We must invest simultaneously in treatment while also scaling up prevention programs including male circumcision, combination prevention, and services targeted for high risk groups.

Let us also not forget that strengthening the health system and getting AIDS treatment to those who need it are not contradictory goals. We know from our experiences in the 1990s, that if treatment isnt there, people will not come to the health centers and doctors and nurses will not stay. We know from our long experience that it is virtually impossible to have successful public sector health and AIDS treatment programs where some people get therapy and others in dire need dont.

The news of President Obamas new Global Health Initiative was received in Africa with great appreciation and enthusiasm. However, to ensure maximum health benefits, we must build on past successes and ensure sufficient new money is available for successful integration of serious health issues. Otherwise, we risk going back to the failed approaches of the 1990s that did not prioritize provision of life saving drugs.

In conclusion, allow me to refer to repeated commitments by the United States to universal access to AIDS services in UN declarations and G8 communiqus, which caused great excitement and expectation in Africa.

US, as a world's friend, came to the rescue of Africa at the time of her greatest need. It is our hope that current efforts can be strengthened so that one day we can achieve our shared goal of a world free of AIDS.

Thank you again very much for this opportunity and to the American people for their compassion and generosity.


Africa: Global Health Advocates and UN Officials Meeting at Westminster Say U.K. and World Leaders Must Keep Their Promise to More Than 10 Million People with AIDS Who Need Treatment

12 March 2010

press release

International Aids Society (Geneva)
http://www.iasociety.org/

With Britain leading the way, G8 leaders pledged at the U.K.-led Gleneagles G8 Summit in 2005 to achieve universal access to HIV prevention, treatment and care by 2010. Significant progress has been made in some areas yet, as the universal access pledge comes due, only one-third of people in need of HIV treatment worldwide receive it, while more than 10 million more people in urgent need of life-saving HIV treatment wait. Most people living with HIV are still unaware of their status. And fewer than half of pregnant women living with HIV receive the drug regimen that can extend their own lives and save their children from infection.

Worse, advocates and leaders meeting here point to worrying signs that political and financial commitments to universal access are faltering, just as they should increase. Funding for the Global Fund to Fight AIDS, Tuberculosis and Malaria, an incredibly successful mechanism that has saved nearly 5 million lives since 2005, is in jeopardy. Canada, host of this year's G8 and G 20 summits (25-27 June), has made little mention of universal access and is now the only G8 nation firmly opposed to the U.K.-endorsed Financial Transactions Tax (FTT), a tiny tax on financial transactions that could raise the billions of Pounds needed to fulfill the universal access pledge.

High-ranking civil society representatives, leading researchers and African governments meeting today with U.K. International Development Minister Gareth Thomas are calling on the U.K. to strengthen its own action on universal access, and work to ensure that the global pledge to achieve HIV prevention and treatment for all is not forgotten at this year's G8 and G20 summits.

"More than 4 million people worldwide are receiving HIV treatment -- an important achievement, but still far from meeting even the most basic assessment of need," said Robin Gorna, executive director of the International AIDS Society and facilitator of today's meeting. "Yet, instead of building on progress, some donor nations and governments of highly affected countries are backing away from the universal access commitment with a series of poorly funded half-measures on AIDS. The situation is now an emergency. New treatment enrollments in many countries are coming to a standstill, the risk of drug resistance is increasing, and fragile gains made over the last 10 years may soon erode, with potentially serious consequences for future efforts to control this epidemic."

"Evidence demonstrates the incredible positive impacts that come from HIV treatment scale up," said International AIDS Society President Julio Montaner. "Broad access to HIV treatment saves lives and substantially reduces new HIV infections by lowering the infectiousness of people with HIV. Well-programmed AIDS funding strengthens health systems and expands access to essential health services such as immunization and vaccination. Today we ask the U.K. to not only redouble its efforts to achieve universal access, but also to work to ensure that the universal access pledge remains high on the global agenda -- at the G8 and G20 summits and beyond."

"This is a commitment we cannot break and a fight we cannot lose. We are still far from reaching the level of care promised for 2010," said singer and AIDS campaigner Annie Lennox. "It is unacceptable that half of the pregnant women who needs drugs to protect their own health and their babies cannot get them; that 10 million people in immediate need of treatment have no access. Governments such as the U.K. that have taken significant action to achieve universal access pledge must take a strong stand to encourage those that lag behind to keep their promises on AIDS."

"The cost of providing universal access to HIV prevention and treatment is a small fraction of the economic, human and social costs of ignoring this epidemic," said Diarmaid McDonald, Stop AIDS Campaign Coordinator. "The current economic slowdown cannot be an excuse to overlook the universal access pledge. The U.K. was instrumental in forging this global commitment. The U.K. must now lead in efforts to ensure that it is met."

"It is shocking that 33 million people around the world are living with HIV and that for every two people receiving treatment there are five new HIV infections," International Development Minister Gareth Thomas said. "The UK has consistently led the international community in efforts to tackle HIV and remains fully committed to getting the drive for universal access back on track. That is why in 2007 the Department for International Development committed landmark funding of 1 billion UK aid to the Global Fund for HIV, TB and Malaria, and why we have called this meeting to look at what more we can do collectively to increase progress on tackling HIV and AIDS."

"The goal of today's meeting is clear," said Asia Russell of the Health GAP Global Access Project. "We need the U.K. to fully assume its leadership role in ensuring that the G8 and G20 nations recommit to achieving universal access to HIV treatment, prevention and care, and to raising the additional resources needed to support a comprehensive, quality global AIDS response."

Note to editors:

Today's high level meeting at the House of Commons includes the following participants:

  • Professor Moses Chirambo, Minister of Health, Malawi
  • Dr Alex Coutinho, Executive Director of Infectious Diseases Institute, Makerere University, Uganda
  • Vuyiseka Dubula, General Secretary, Treatment Action Campaign, South Africa
  • Ambassador Eric Goosby, USA
  • Robin Gorna, Executive Director, International AIDS Society
  • Professor Rachel Jewkes, Director, Gender & Health Research Unit, Medical Research Council, South Africa
  • Dr Michel Kazatchkine ED, Global Fund to fight AIDS TB & Malaria
  • Hon. Esther Murugi Mathenge, Minister for Gender, Children and Social Development, Kenya
  • Professor Narciso Matos Director of the Foundation of Community Development (FDC), Mozambique
  • Professor Julio Montaner, President, International AIDS Society
  • His Royal Highness Chief Mumena, Zambia
  • Rev Dr Nyambura Njoroge, Executive Coordinator of the Ecumenical HIV & AIDS in Africa Initiative for the World Council of Churches.
  • Nelson Otwona, NEPAK (National Empowerment Network of People Living with HIV/AIDS in Kenya).
  • Dr. Sam Phiri, Executive Director, the Lighthouse Trust, Malawi
  • Dr Yogan Pillay, Deputy Director General Strategic Health Programmes. Ministry of Health, South Africa
  • Asia Russell, Health GAP
  • Michel Sidibe, Executive Director UNAIDS
  • Professor Alan Whiteside, HEARD /University of KwaZulu Natal
  • Hon Benedict Xaba, Minister of Health & Social Welfare, Swaziland

Dramatic reduction in malaria deaths by 2015 possible; on track to meet global TB targets

Press Release
08 March 2010

Global Fund to Fight AIDS, TB and Malaria
http://www.theglobalfund.org

[Excerpts only. For full press release and 2010 Progress Reports go to http://www.theglobalfund.org/en/media/]

Geneva Virtual elimination of mother to child HIV transmission by 2015 is now within reach if current rates of progress by Global Fund-supported programs and other efforts are maintained. Malaria may be eliminated as a public health problem within a decade in most countries where it is endemic. Tuberculosis prevalence in many countries is declining and the international target of halving TB prevalence could be met by 2015.

These are projections from the Global Funds 2010 Results Report, released today. They are contingent on the current rate of scaling up of health investments for the three diseases being at least maintained and ideally accelerated further.

A world where no children are born with HIV is truly possible by 2015, says Professor Michel Kazatchkine, Executive Director of the Global Fund. It is also possible now to imagine a world with no more malaria deaths, since already an increasing number of countries have been reporting a reduction in malaria deaths of more than 50 percent over the past couple of years. No other area of development has seen such a direct and rapid correlation between donor investments and live-saving impact as these investments in fighting AIDS, TB and malaria.

According to the report, Global Fund-supported programs saved at least 3,600 lives per day in 2009 and an estimated total of 4.9 million since the creation of the Global Fund in 2002. These are people who would otherwise be dead, had it not been for interventions supported by the Global Fund.

The Global Fund is about getting results. This report clearly shows the world's investments are making a difference, said Mr Michel Sidib, Executive Director of UNAIDS. However AIDS is not over in any part of the world and without a fully funded Global Fund, our shared dream of universal access to HIV prevention, treatment care and support could become our worst nightmareputting the lives of millions of people currently on treatment in jeopardy and millions of pregnant women in a position not able to protect their babies from becoming infected.

The Results Report forms part of the documentation for donors in preparation for the Global Funds replenishment conference in October 2010 in New York, where the organization will ask donors for financial contributions for 2011-2013. This is the third time since the Global Fund was established in 2002 that donors are being asked to replenish its finances.

At an initial Replenishment review meeting to be held in The Hague on 24 March, the Global Fund is presenting three resource scenarios for consideration to donors, each with an indication of the results that could be expected in terms of achievements on the ground at the end of the replenishment period. The different scenarios range from US$ 13 to 20 billion for the three-year period.

By the end of 2009, Global Fund-supported programs provided antiretroviral treatment to 2.5 million people, treatment to 6 million people who had active TB and had distributed 104 million insecticide-treated nets to prevent malaria. In addition to averting at least 3,600 deaths daily, the programs prevent thousands of new infections and alleviate untold suffering and economic loss for poor families in 144 countries.

Established as a public-private partnership to mobilize and intensify the international response to the three global epidemics and help achieve the UN Millennium Development Goals (MDGs), the Global Fund has disbursed US $10 billion for HIV, TB and malaria efforts through December 2009.

The coming years will see even more results, as half of the total disbursements by the Global Fund were delivered in 2008 and 2009. In addition, much of the US$ 5.4 billion of financing approved in the last two rounds of proposals (8 and 9) will reach countries in 2010 and 2011, and will continue to significantly boost health outcomes.

The progress in combating AIDS, TB and malaria as a result of these investments has also had a positive impact on child mortality and maternal health. The MDGs call for halting and reversing the major diseases as well as reducing child mortality and improving maternal health by 2015.

Global Fund grants have made significant contributions to reducing the largest causes of mortality among women and children. This is particularly the case in sub-Saharan Africa, where HIV, TB and malaria are responsible for 52 percent of deaths among women of childbearing age and malaria alone accounts for 16 to 18 percent of child deaths.

Results by Disease, up to December 2009

HIV

  • 2.5 million people are currently on antiretroviral therapy (ART), a level of coverage deemed unattainable less than a decade ago.
  • AIDS mortality has declined in many high-burden countries.
  • The Global Fund contributed about one-fifth of all disbursements by bi- and multilaterals for the HIV response in low- and middle-income countries in 2008.
  • 1.8 billion condoms distributed.
  • 105 million HIV counseling and testing sessions provided.
  • 790,000 HIV-positive pregnant women in low- and middle-income countries received antiretroviral prophylaxis to prevent mother-to-child transmission which represents 45 percent of coverage of women in need.
  • 4.5 million basic care and support services provided to orphans and other children made vulnerable by AIDS.

Tuberculosis

  • Around 6 million people with active TB were treated by December 2009.
  • 1.8 million TB/HIV services provided a 150 percent increase since the end of 2008, contributing to the decline of TB prevalence and mortality rates in many countries.
  • The Global Fund provides 63 percent of the external financing for TB and multidrug-resistant TB (MDR-TB) control efforts in low- and middle-income countries it is by far the major source of international funding for tuberculosis.
  • Today, countries are on track to meet the international target of halving TB prevalence by 2015.

Malaria

  • 104 million insecticide-treated nets distributed to prevent malaria; more than 19 million indoor residual spraying of insecticides in dwellings; 108 million cases of malaria treated in accordance with national treatment guidelines.
  • An increasing number of countries reporting a reduction in malaria deaths of more than 50 percent. At least ten of the most endemic countries in Africa have reported declines in new malaria cases and an impressive decline in child mortality of 50 to 80 percent.
  • In 2008, the Global Fund contributed 57 percent of international disbursements for malaria control which makes it, by far, the major source of international funding for malaria.
  • In Africa, Swaziland and some island states and territories are now aspiring to enter the malaria pre-elimination stage.

Progress towards meeting Millennium Development Goals

The report points out that continued, substantial increases in long-term financial commitments by donors will be needed to consolidate the gains and to reach the MDGs by 2015.

Within that time-frame, 2010 is decisive.

Funds committed now will benefit programs which will have effect on the ground from 2012 to 2015. The numbers show that countries are approaching a positive tipping point: if they continue on this path, the returns will be exponential and the world will reverse the AIDS, TB and malaria epidemics.

In health, 2010 is a pivotal year to finance the final stretch of the effort to reach the Millennium Development Goals, says Professor Kazatchkine. We have made unprecedented progress but it is fragile. If we lose momentum now there will be a heavy price to pay. A failure to continue the scale-up of investments in health will betray the trust of millions.

...

[For more information:

Andrew Hurst Communications
Office: + 41 58 791 16 72
Mobile: + 41 79 561 68 07
E-mail: andrew.hurst@theglobalfund.org

Marcela Rojo Communications
Office: + 41 58 791 16 79
Mobile: + 41 79 540 26 67
E-mail: marcela.rojo@theglobalfund.org ]


AfricaFocus Bulletin is an independent electronic publication providing reposted commentary and analysis on African issues, with a particular focus on U.S. and international policies. AfricaFocus Bulletin is edited by William Minter.

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