LESSONS FROM B(R)ICS: AN EFFECTIVE AND SCALED-UP AIDS RESPONSE

Dirceu Greco, director of the department of STD, AIDS and viral

hepatitis of the Brazilian Ministry of Health, at the International

AIDS Conference. Photo by: © Ryan Rayburn / IAS

How can Brazil, South Africa, India and China contribute to the global AIDS response?

This was the topic of discussion at one of the major sessions on day three of the International AIDS Conference in Washington, D.C. Health officials from these emerging economies shared how their countries were able to scale up HIV treatment and prevention. Three things were made clear:

• Leadership is “extremely” important. While a change in perception of HIV and AIDS was necessary, a stronger political and financial commitment was more important.
• Participants to the AIDS response must adopt a scientific method of tracking vulnerabilities, achievements and interventions, and a no-strings-attached approach to sharing of technical
  expertise.
• Enable sustainable production of high-quality, low-cost generic medicines.

These four countries have been able to make significant gains in the fight against HIV and AIDS. South Africa has now been able to put 1.7 million people on antiretroviral therapy and reduce the rate of mother-to-child HIV transmissions from 8 percent in 2008 to 2.7 percent as of last week. Before the severe acute respiratory syndrome outbreak in 2003, most of China’s resources for AIDS programs came from international funding. Now, the Chinese government funds 80 to 90 percent of the country’s total AIDS budget.

In Brazil, a law mandating everyone who needs antiretroviral therapy should be given medicines was passed in 1996. Since then, Brazil has been able to make available 20 types of antiretroviral drugs, of which 10 are produced locally. All of the country’s funding to HIV treatment and prevention came only from taxes.

Dirceu Greco, director of the department of STD, AIDS and viral hepatitis of the Brazilian Ministry of Health, also had this to say: People should see how Brazils’ unified public health system works and see if it can be done in other countries.

Meanwhile, several other sessions and panel discussions were held.

Among the issues discussed at the Challenges and Solutions plenary session is translating scientific advances on HIV treatment and prevention into affordable health programs that can be adopted even in resource-limited settings. Antiretroviral therapy is one example. While the treatment can stop the progression of HIV and reduce transmission, experts continue to debate when therapy should start and what kind of regimen should be given.

The global economic slump has resulted in declining donor funding for HIV and AIDS. So how should aid agencies and recipients maximize the resources they are given? Presentations from the Joint U.N. Program on HIV/AIDS, the Office of the U.S. Global AIDS coordinator, Tanzania and Zimbabwe attempt to offer suggestions for strategic use of resources.

Funding isn’t just the only resource that’s become increasingly scarce. There is now a global shortage of “qualified and available” HIV health personnel, especially in Africa: The Global Health Workforce Alliance says 1 billion people do not have access to a skilled health worker, while the World Health Organization estimates 4 million additional health workers are needed.

But, the HIV and AIDS fight can’t be won through a purely medical approach. This was the argument International Development Law Organization’s Naomi Burke-Shyne made in a guest op-ed she penned for Devex Tuesday (July 24). This is also the topic of discussion at a session that talked about the findings and recommendations of the Global Commission on HIV and the Law. While there are good laws that help in the fight against HIV, there is an “epidemic of bad laws” and that a “comprehensive and humane approach to law reform” is needed to effectively protect the rights of HIV-positive people.

Here’s what else transpired on the third day of the international conference, along with a few essential reads.

• Médecins Sans Frontières released a “first-of-its-kind” study that maps the progress of HIV treatment policies, tools and strategies in 23 countries. Among the report’s main findings: 11 of the 23 countries in the study are providing antiretroviral treatment to 60 percent of people who need it while six countries are reaching only one-third of people in need. This study was released a day after the medical organization unveiled a report discussing the need to increase access to viral load monitoring in developing countries. Viral load testing — or measuring the presence of HIV in a person’s blood — has been a routine procedure in developed countries to help people stay on antiretroviral combination therapy longer and prevent building resistance against the drug. But the test is expensive and cannot be easily adapted to “resource-limited settings.”
• What is the connection between hunger and malnutrition, and HIV treatment? Health and policy experts discussed the impact of food assistance on HIV treatment at a side event hosted by the Harvard Medical School and Partners in Health. U.N. World Food Program Chief of Nutrition and HIV Policy Martin Bloem said providing food aid to people living with HIV helps “fight off illness and regain their health and strength.” Bloem moderated the discussion, where Rwandan Minister of Health Agnes Binagwaho said: “Most people living with HIV don’t have enough food, and they need more food. So the only thing to do is to give it to them.” Meanwhile, researchers at an Irish college received a $1.2 million grant from Irish Aid to study the “complex interactions” between nutrition and food security, HIV and AIDS, and socio-economic factors in Uganda.
• U.S. Senators Patrick Leahy and Lindsay Graham hosted a bipartisan briefing to discuss ways to maximize new opportunities in the HIV and AIDS response. Leahy said bipartisan support could allow the United States’ AIDS response to be taken out of politics. Representative Kay Granger, meanwhile, said the U.S. AIDS response must be targeted and smart, and that resources must be used effectively.
• At a panel discussion exploring the role of faith-based organizations in the fight against HIV and AIDS, key personalities from various religious groups admitted many organizations were slow to respond and were hesitant to talk about anything related to sexuality, which is a key topic in any AIDS discussion. But faith-based organizations are slowly moving “from apathy to awakening,” although many of them still need to gain people’s trust.
• Bill Gates was honored by amFAr, GBCHealth and The Foundation for AIDS Research for his leadership on efforts to end HIV and AIDS. He joins past Award of Courage recipients such as Bill Clinton. In his speech, the Bill & Melinda Gates Foundation co-chairman once again pressed for innovation, which he said is key to addressing problems like AIDS that “that people thought were unsolvable.”
• The head of the International Labor Organization’s HIV and AIDS program said the private sector needs to be more involved in efforts to fight the disease. Alice Ouedraogo highlighted the need to help private firms develop and implement policies against discrimination and stigma within their workplace. This would help companies understand AIDS better, which in turn could spur support for prevention programs for groups beyond their own workforce, Ouedraogo added.
• Health experts and academics tackled during a side event the issue of stigma among transgender and other HIV-vulnerable populations. The audience at the Human Rights Campaign-hosted event heard expert opinions on why stigma exists and how it can be addressed and eliminated.
• African political and traditional leaders, and key figures from the U.S. President’s Emergency Plan for AIDS Relief, UNAIDS, WHO, AVAC and Champions for an HIV-Free Generation convened at a satellite event to discuss challenges and solutions to voluntary medical male circumcision for HIV prevention in East and Southern Africa. Three clinical trials have proven how male circumcision can reduce female to male transmission of HIV 60 percent, but “political, traditional and community leaders” must work further to change men’s attitudes.
• ONE tapped the creative team at Funny or Die to get the message out: The world must come together to realize the beginning of the end of AIDS. Hollywood celebrities Zach Galifianakis, Sarah Silverman, Tracy Morgan, Marisa Tomei, Isaiah Mustafa and Chloë Moretz participated at the video, which will be released at the International AIDS Conference.
• Compassion. Dignity. Love. These are the keys to turning the tide on AIDS, according to philanthropist and musician Elton John. The epidemic, he said, is not fueled by HIV but by ignorance and hate. John stressed the importance of addressing shame and stigma to encourage more people to protect themselves.
• While the focus of this year’s AIDS conference is on the quest to find a vaccine and a cure for HIV and AIDS, Skoll Foundation CEO Sally Osberg says “big wins also beckon in the near term.” In an opinion piece for the Huffington Post, Osberg extolls the advances U.N. agencies, the United States, civil society organizations, and other donors and advocates have made over the past year. Most notable for Osberg are the plans to eliminate new HIV infections among children by 2015 and keep mothers alive. Programs such as mothers2mothers — which the foundation has given a $2.5 million grant — educate and provide emotional support to HIV-positive pregnant women and mothers. “We think of innovations as new technologies,” Osberg writes, adding that in health care “innovations are often as simple as pregnant woman with HIV talking with a similarly-affected peer who has successfully navigated the treatment process.”
• HIV prevention and public health expert Daniel Halperin makes a case for more local ownership of donor-backed prevention campaigns. Prevention services should also be delivered as part of an integrated health service package instead of “being overly linked to AIDS” programs, he opines on the Los Angeles Times.
• What can other countries learn from Chinese officials’ efforts to reverse the rise of HIV and AIDS in the country? Min Dai and Yuji Feng explore the history of the disease in China and the country’s progress so far, as well as its remaining challenges, in a blog post on the Gates Foundation’s Impatient Optimists blog.
• MSF cautiously welcomed U.S. Secretary of State Hillary Clinton’s announcement of new U.S. funding for various HIV and AIDS related initiatives. The humanitarian group said the pledge is “good news” and encouraged other countries to follow suit. But the pledge and overall U.S. efforts to fight the disease could be undermined by the country’s push for the Trans Pacific Partnership trade agreement, MSF said.
• Should donors such as the World Bank and the United States increase funding for AIDS treatment and prevention, even while there are other pressing health concerns in the developing world that warrant greater attention than they are currently receiving? This was the subject of a debate the World Bank, the U.S. Agency for International Development, PEPFAR and The Lancet hosted July 23. Roger England, chair of the Health Systems Workshop in Geneva, pointed out that “8 million kids die before their 5th birthday each year, and rarely from HIV.” But economist Jeffrey Sachs argued that “it is our job to raise our voices clearly to say that we don’t want to live in a world where people are allowed to die for no reason.”
• DEVEX