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Foreign Aid to Rwanda

Foreign Aid to RwandaRwanda is a small, hilly, landlocked country in sub-Saharan Africa with around 14 million people. The 1994 genocide against the Tutsi destroyed many essential government buildings and services, completely devastating the country. The international community largely regards the Rwandan government as an “effective development partner”. They see the country as one that employs international aid efficiently to implement its rebuilding and development strategies. Rwanda’s reputation stems from the government’s strong capacity to implement policies with minimal corruption. This ensures that no aid or natural resources are misused or wasted. Rwanda has a good history of aid going directly towards policies that benefit the population and foster sustainable development. Foreign aid to Rwanda showcases encouraging results and serves as an example for other countries.

Major Donors to Rwanda

The major foreign country donors to Rwanda are the U.S., Germany, France and Japan. As of 2021, Rwanda’s biggest donor was the U.S., donating $174 million. In total in 2021, Rwanda received $1.3 billion in foreign aid. The country receives some of the largest aid per capita compared to its regional neighbours. In 2021, Rwanda received $98 in aid per capita, greater than $55 for Uganda, $37 for the Democratic Republic of Congo (DRC) and $47 for Burundi during the same year.

Foreign aid to Rwanda has come under more scrutiny lately as international donors have expressed concern over the country’s role in supporting human rights abuses and conflict in the DRC with its reported support of the rebel military group M23. Rwanda’s reported involvement in the current conflict in the DRC. culminated in the U.S. suspending aid in 2012. Currently, Rwanda is still facing international pressure from countries like France to stop its support of M23 and is threatening to reduce foreign aid to Rwanda if it continues to support the conflict.

Health Care Aid

Most foreign aid to Rwanda from the U.S. goes to improving the population’s health by investing in preventative HIV/AIDS measures and basic health, such as malaria prevention. According to BMJ, “Rwanda was among the first African countries to document AIDS cases in 1983, and subsequent HIV/AIDS surveillance has confirmed that Rwanda’s HIV epidemic is longstanding and severe in many settings.”

There has always been a massive divide between the prevalence of HIV/AIDS in rural and urban settings. At its peak in 1986, the urban prevalence of HIV was 17.8%, while the rural prevalence was 1.3%, according to BMJ. The investment into preventative HIV/AIDS measures has resulted in a 56% reduction in new HIV infections over the last 15 years, a dramatic decrease among the population in the country that is on track to remove the HIV epidemic in the country.

U.S. supports Rwanda’s fight against HIV/AIDS through the President’s Emergency Plan for AIDS Relief (PEPFAR). This program is a global initiative that aims to fight the HIV/AIDS epidemic in countries by funding antiretroviral therapy, supporting prevention programs, and investing in health care infrastructure.

Education

Another significant investment Rwanda makes using foreign aid is in primary education for children. The great priority the government has given to education has enabled Rwanda to sustain near-universal access to primary education for over a decade. The focus on education has allowed more children to get an early start to learning through schooling with gender parity. Early education is the first step for Rwanda to develop its economy, reduce poverty and increase its quality of life. Aid from foreign countries has been integral to Rwanda’s impressive economic development since the 1994 genocide. Rwanda has consistently had positive GDP growth, except for the COVID-19 pandemic in 2020. However, Rwanda has seen a recovery in 2022 as the GDP grew by 8.2%.

Rwanda has an ambitious goal of being a middle-income country by 2035 and a high-income country by 2050. Policy decisions in Rwanda consider these goals and are highly influential in how it uses the foreign aid it receives. Foreign aid to Rwanda is necessary for its development to reach these goals, and it can not succeed by its production alone. Rwanda has positively utilized foreign aid to rebuild the country after the devastating 1994 genocide. In many respects, it is quite remarkable how much the country has developed after the genocide and how much it has exceeded people’s expectations for the country. While there are concerns about a decrease in future aid because of human rights concerns, foreign aid remains an essential source of support for Rwanda’s development goals and increasing the quality of life.

– Mathieu Paré

Mathieu is based in Toronto, Canada and focuses on Politics for The Borgen Project.

Photo: Unsplash

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Comoros HIV Prevention

How Comoros is Succeeding Against HIV In Comoros, a small island nation, efforts to combat HIV through the Prevention of Mother-to-Child Transmission (PMTCT) program are yielding promising results. According to the National Health Service (NHS), human immunodeficiency virus (HIV) compromises the immune system, hindering the body’s ability to fight infections. The virus, transmissible through bodily fluids, can pass from mother to child during pregnancy, birth or breastfeeding. However, PMTCT programs are proving effective, with proper health care reducing transmission rates to under 1%.

Challenges in PMTCT Implementation

HIV is deadly, killing 50% of infected children before their second birthday if they do not receive treatment. PMTCT is crucial, as it accounted for 90% of child HIV infections in 2018. Unfortunately, in lower-income countries, mother-and-child services and PMTCT programs often face staffing and resource shortages, making it challenging for countries and organizations to implement these programs on a large scale.

Global guidance, including WHO’s Strategic Direction 4, mandates that policies and programs ensure services are culturally appropriate and responsive to community needs, addressing stigma, discrimination and social and structural barriers. Institutions such as UNICEF are working toward eradicating AIDS by 2030, in partnership with the Global Alliance to End AIDS among children and adolescents and the UNAIDS Joint program. These organizations’ goals focus on widespread HIV testing and treatment to combat the epidemic.

Global Efforts and Local Success in Comoros

In Comoros, continued efforts from PMTCT programs have reduced HIV prevalence to just 0.03% among expectant mothers. The Ministry of Health implemented a national policy that mandates training health workers and raising awareness among pregnant women during prenatal consultations. This approach has yielded impressive results: no HIV-positive mothers have given birth to HIV-positive children and all HIV-positive pregnant women received ARV treatment by 2021.

Comoros’ PMTCT Achievements and Future Goals

The PMTCT program in Comoros has achieved remarkable success, partly due to international assistance. In 2020, UNICEF supplied health facilities with critical equipment and supplies, including reagents for HIV testing, essential for preventing mother-to-child transmission of HIV. This support plays a crucial role in the Ministry of Health’s strategy, focusing on testing and training.

While Comoros has made significant progress, its mission continues. The Health Ministry has launched an ambitious strategy for 2025 aimed at eradicating new HIV infections in infants born to HIV-positive mothers, ensuring that three-quarters of pregnant women know their HIV status and reducing new infections by 75% from 2020 levels.

Looking Ahead

Comoros is poised to continue its successful implementation of the PMTCT program, aiming to eliminate new HIV infections among newborns. With international support and effective local strategies, the nation expects to significantly reduce transmission rates. The Ministry of Health’s proactive measures in training and equipping health care providers could further strengthen the program’s effectiveness. By 2025, Comoros aims to have the majority of pregnant women aware of their HIV status, a critical step in prevention efforts. These concerted efforts are vital for sustaining progress and achieving the goal of eradicating AIDS in children and adolescents within the nation.

– Rachael Denton-Snape

Rachael is based in High Wycombe, UK and focuses on Good News and Global Health for The Borgen Project.

Photo: Unsplash

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How the Global Fund Is Fighting HIV/AIDS

The Global FundThe Global Fund is a “Global Health Partnership” that receives funds from different sources, including the private sector, foundations and governments, to fight human immunodeficiency virus (HIV) and acquired immune deficiency syndrome (AIDS), Malaria and Tuberculosis. The partnership was established in 2002 and has saved 59 million lives by investing more than $60 billion in global health care systems to help ensure equal access to care across the world. The Fund’s HIV/AIDS goals include, but are not limited to, fulfilling the World Health Organization’s “Treat All” guidance and the United States Agency for International Development’s (USAID) 95-95-95 strategy.

What Is HIV/AIDS?

HIV is a virus that damages a person’s immune system, making them more susceptible to infections and other diseases. AIDS, on the other hand, is used to describe the often life-threatening infections and illnesses that occur after damage to the immune system has been caused by HIV.

HIV can be contracted by anyone through the body fluids of an infected person, through unprotected sex, sharing needles or transmission from mother to baby (via pregnancy, birth or breastfeeding). When discussing these interrelated terms, it is important to note that while HIV can be transmitted, AIDS cannot be.

With HIV treatment, “most people” can be prevented from developing AIDS-related illnesses and can get to the point of having an “undetectable viral load.”

WHO’s Treat All Guidance and USAID’s 95-95-95 Strategy

HIV is a global health care problem and as such, global organizations have set strategies in place. In 2016, the WHO launched the “Treat All” plan to tackle the number of people living with HIV, where it recommended that “all people living with HIV be provided with antiretroviral therapy (ART)” with the aim of reaching all 37 million with the virus.

Furthermore, USAID has set out another global strategy. Its 95-95-95 strategy is an HIV plan that has the following aims for 2025:

  • 95% of women in their reproductive years receive comprehensive HIV and sexual and reproductive health services.
  • 95% of pregnant and breastfeeding women diagnosed with HIV achieve viral load suppression.
  • 95% of children born to HIV-positive mothers undergo testing for potential exposure to the virus.

The Global Fund says it is “making significant progress” toward fulfilling both the WHO and USAID guidance.

Key Populations and Why They Matter

The WHO defines a key population as a group that “frequently face legal and social challenges that increase their vulnerability to HIV, including barriers to accessing HIV prevention, treatment and other health and social services.” According to USAID, 70% of new HIV infections occur in key populations and can go unresolved due to factors like stigma, human rights violations and violence.

The Global Fund has found that due to COVID-19, progress in the prevention and treatment of HIV/AIDs was reduced, with key populations being left behind, including children, adolescent girls and young women. For instance, there is a high disparity in care between children and adults, with 43% of HIV-positive children being unable to access lifesaving treatment compared to 23% of HIV-positive adults. Targeted health care tailored to these populations is crucial. Failure to address their infection rates undermines the long-term goal of eradicating HIV and AIDS.

What Has the Global Fund Done?

So far, the Global Fund has invested more than $25.5 billion in global HIV/AIDS care, providing more than a quarter of all international financing for this disease. Furthermore, in 2022, the organization provided antiretrovirals for 24.5 million people. In the same year, more than 15 million people, including 710,000 HIV-positive expectant mothers, received preventative care as a result of the partnership.

In fact, in the countries where it provided care, 82% of mothers were able to prevent the spreading of HIV to their babies. Moreover, due to the high number of HIV tests carried out, 53.1 million, the Global Fund was able to create a 72% reduction in AIDS-related deaths in countries where it operates.

The partnership has also identified 13 countries that have been made a priority, where key populations such as young women and adolescent girls are specifically targeted to benefit from HIV prevention programs. This is because they are “more than three times as likely” to contract HIV than their male counterparts.

Looking Ahead

In July 2021, the Global Fund released its 2023-2028 strategy, a continuation of all the work that it has done so far to improve health care outcomes globally. Its mission is officially to “To attract, leverage and invest additional resources to end the epidemics of HIV, tuberculosis and malaria, reduce health inequities and support attainment of the Sustainable Development Goals.” Ultimately, it aims to create a world that is healthier and better for all.

– Rachael Denton-Snape

Rachael is based in High Wycombe, UK and focuses on Global Health for The Borgen Project.

Photo: Flickr

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Niger’s HIV/AIDS Prevention Strategies and Government Initiatives

Niger's HIV/AIDSNiger is a landlocked country in West Africa that boasts a youthful demographic, with 58% of its population aged less than 18. Compared to many other sub-Saharan African countries, Niger has made notable strides in addressing its disease burden indicators. Presently, Niger’s HIV/AIDS prevalence rate stands below 1%, with 0.2% among adults aged 15 to 49.

According to reports by Global Fund, the rise in new cases has significantly fallen by three-quarters since 2002. This progress can be attributed to the collaborative efforts of the government and international nongovernmental organizations (NGOs), which have played pivotal roles in advancing Niger’s fight against HIV/AIDS over the years.

Efforts by Niger Government

In 2011, the Niger government committed to preventing mother-to-child transmission (PMTCT) of HIV, with the aim to eliminate HIV infections in infant children by 2015. This commitment is evident in the increased funding allocated to expand Niger’s PMTCT services, which rose from 2.6% of its total budget in 2010 to 15.9% in 2011. Similarly, Niger expanded its PMTCT pilot sites from seven in 2003 to 651 in 2012. Currently, HIV/AIDS infection among exposed infants is nearly non-existent, with 26,000 children born to HIV-positive mothers remaining uninfected and the current HIV prevalence rate among infants is 5%.

Additionally, condom social marketing was introduced in Niger in 2003 as part of the government’s efforts to combat HIV/AIDS. Targeted distribution of condoms has been a key strategy, with mobile vendors and kiosks providing access to condoms even along major transportation routes. The provision of free condoms has led to positive changes in sexual behavior. Between 2006 and 2011, there was a significant increase in the percentage of young men engaging in protected casual sex, rising from 38% to 66%.

Furthermore, in Niger, the health care sector offers HIV counseling and testing (HCT) as an integrated part of health services, available at blood transfusion centers and PMTCT sites. In 2008, the country had 172 HCT sites. However, by 2012, only 7-8% of females and 3% of males had undergone HIV testing. The higher percentage among women is attributed to PMTCT-related HCT services. The same year, the government allocated specific resources for provider-initiated counseling and testing (PICT). This initiative aimed to target individuals who were already in contact with the health sector and those at risk of HIV infection due to factors like multiple sex partners, unprotected sex or a history of sexually transmitted infections (STIs).

Efforts by External Support

The Global Fund plays a critical role as a significant grant provider for Niger’s HIV/AIDS initiatives. Out of the total active grants amounting to €153.50 million (about $165 million) from 2021 to 2024, about 10% is directly allocated for HIV interventions in the country. Despite the relatively low prevalence of HIV/AIDS in Niger, specific key populations, such as prisoners, sex workers and homosexual individuals, remain disproportionately affected. Testing rates also continue to be low, with approximately 25% of adults and 50% of children unaware of their HIV status.

Between 2007 and 2012, the Global Fund grants accounted for 28% of the country’s spending on HIV/AIDS interventions. The Global Fund grants aim to achieve ambitious targets such as reducing new HIV infections and mortality rates, enhancing living conditions for people living with HIV and strengthening both the demand for and supply of quality health care and services for the entire population.

The United Nations Children’s Fund (UNICEF) also supported the Niger government in its fight against HIV and AIDS in 2018. UNICEF worked on a plan to increase HIV testing, treatment and PMTCT. By the end of the year, 96% of health facilities were providing PMTCT services. However, only 10% of babies born to HIV-positive moms were tested for HIV within two months of birth. This was because of limited medical equipment to carry out the tests.

To address this issue, UNICEF intervened by promoting the use of GeneXpert Point of Care machines already present in 12 laboratories nationwide. UNICEF also provided training and materials to 24 laboratory technicians, which enabled all regions of Niger to test HIV-exposed babies. UNICEF’s support to the government has led to 342,820 out of 417,393 women attending their first antenatal consultation to receive counseling and testing for HIV.

– Teniola Yusuf

Teniola is based in Norwich, UK and focuses on Global Health for The Borgen Project.

Photo: Flickr

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Spotlight on Danceaid

DanceaidDanceaid is a charity based in the United Kingdom (U.K.) that uses the energy of dance to transform the lives of children. Using dance-based activities, the charity raises funds to alleviate certain hardships that are often experienced by orphaned, poor and disabled children, both in the U.K. and abroad. The programs it runs focus on things such as food insecurity and education, with the aim of helping children in need reach their full potential.

Founded in 2009, Danceaid uses slogans such as “dance a little, live a little, save a life” and wants to get everyone involved, from “tiny tots to groovy grannies shaking a leg to make a difference.” DanceAid runs a whole range of dance-based events and activities to raise funds. For example, it runs dance competitions and shows, a “design your own medal hanger” scheme, triathlons and danceathons and has celebrity endorsement from JLS star Aston Merrygold.

The Main Aim of the Charity

The main aims of the charity are education and training, the prevention and relief of poverty, overseas aid and famine relief. It does this by providing finance, human resources, buildings, facilities, open space and aid services. The charity primarily operates throughout England and Wales, the Philippines, South Africa, Syria, Turkey and Ukraine.

Impacts

A key example of Danceaid’s work is in the city of Manila, the capital of the Philippines. In Manila, children are forced to live and work in the streets from as young as 3 years old and face serious problems such as food insecurity. In August 2013, Danceaid launched a “feeding program,” just after the city had been hit by monsoon floods, leaving the community without food. The charity currently feeds 100 children every day in Manila. A year later, in 2014, it launched a feeding and support program for Manila entitled Mama and Me. This program is for mothers who are so malnourished that they cannot produce breast milk and for babies who are malnourished, underweight and unwell.

Danceaid also runs projects in rural South Africa, with a focus on young people affected by HIV and AIDS. Its preschool for children aged 3 to 6 provides children with food, toys, books, education on topics such as colors, numbers and patterns and language education in both local languages and English. The charity also runs a drop-in center for affected families, which not only provides cooking utensils and food but also basic fuel to cook.

Also in South Africa, Danceaid currently runs a football program for 100 young boys, with under 13, under 15 and senior teams. The funds Danceaid raises get to put toward footballs, football boots, registration fees for players, transport to games and a healthy meal before engaging in the sport. Since Danceaid initiated this program, one of its players has subsequently been elevated to the South African Premiership, indicating its significant success.

– Eva McMonigle
Photo: Pexels

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Addressing Mental Health in Lesotho

Mental Health in LesothoThe Kingdom of Lesotho is located in South Africa and has a population of two million. Right now, the country is facing its own unique set of struggles and issues. Concentrated areas are often poverty-stricken due to limited employment opportunities, lack of access to necessities and services, as well as high vulnerability to environmental and economic crises. About 24% of citizens in Lesotho live in extreme poverty, while around 580,000 citizens suffer from food insecurity. Additionally, Lesotho has one of the highest HIV prevalence rates in the world at 22.7% as of 2023, as well as a high rate of tuberculosis, which is greatly affecting the health of the country’s already limited health care workers.

These problems compromise the state of mental health in Lesotho. In fact, the latest report shows that the country had one of the highest rates of suicide in the world for that year, with 87.5 suicide-related deaths for every 100,000 deaths. These numbers are alarming and justify claims that state that there is a mental health crisis in Lesotho. The existence of such a severe mental health crisis serves as a testament to the challenges and stressors endured by the Basotho people.

Despite the acknowledgment of such a crisis, many Basotho will not seek help, whereas many others cannot afford to do so. Lesira Rampa, a Lesotho native, wrote, “Unfortunately, there are numerous challenges in accessing mental health treatment in Lesotho, as evident from the alarming suicide statistics. Despite facing stigma, we encounter several problems, including a shortage of mental health care services and limited financial resources to afford expensive treatments.” In light of these obstacles that prevent Lesotho citizens from accessing mental health services, many organizations such as Help Lesotho, Dolen Cymru and Sentebale are working within the country to assist those in need.

Increasing the Number of Mental Health Care Providers

Lesotho has been suffering from what experts call a “brain drain,” which is the emigration of trained professionals from their country of origin to other countries in order to find jobs. This brain drain has made it difficult for Lesotho to retain a stable number of health care workers, causing a great amount of strain on the physicians and nurses who choose to stay. This shortage has detrimentally impacted the quality and quantity of mental health services available to those suffering from mental illnesses.

Paul Myres, Vice-President of the nonprofit organization Dolen Cymru, told The Borgen Project in an interview that, currently, there are no psychiatrists in Lesotho. In order to remedy this issue, Dolen Cymru administers mental health training, which was developed by the World Health Organization (WHO), to upskill general health care providers within the country. Myres describes the training program as a WHO-designed, multi-professional training program that Dolen Cymru was tasked with implementing. It involved just five days of instruction and relied heavily on algorithms, with a structured approach of asking questions to gather patient information and proceeding accordingly based on the responses.

More than 100 health practitioners received this training, which has aided in improving the understanding of mental health among general Lesotho nurses and doctors. Myres says that the philosophy of Dolen Cymru is to capacitate rather than to provide direct care. Such a unique and innovative philosophy can prove effective in empowering citizens to seek out more information on mental health concerns while preserving their dignity.

One-On-One and Group Counseling

There are a generous number of organizations working in Lesotho to provide help during this mental health crisis, each with its unique approach. Help Lesotho is an organization that focuses on providing one-on-one and group counseling to those in need. Help Lesotho offers a range of non-intensive and long-term intensive self-help and life-skills programs. Its variety of programs is designed to benefit parents, children and communities. These programs address mental health concerns stemming from issues such as poverty, grief and loss, HIV/AIDs and much more.

In 2023, Help Lesotho’s long-term intensive programs had more than 2,000 participants and the organization had one-on-one psychosocial support conversations with more than 960 people. Those who received assistance and guidance from Help Lesotho noticed an increase in confidence, a new-found sense of belonging and a desire to inspire others.

Stigmas: Obstacles To Providing Mental Health Support

Although several organizations are addressing the need for mental health services in Lesotho, certain obstacles can stand in the way of their efforts. It is especially difficult to reverse the effects of the social stigmas surrounding mental health in Lesotho. Meyers mentioned in his interview with The Borgen Project that mental health issues are often seen as a punishment in Lesotho, either for the individual or even their parent’s behavior.

Ms. Mota, a psychiatric nurse at Mohlomi Hospital, has spoken out about these stigmas, stating that “Because of misconceptions and stigma surrounding mental health issues, people sometimes suffer in silence and do not seek treatment for their conditions.”

Thankfully, training and programs such as the ones offered by Dolen Cymru can help reduce the influence of such stigmas. Meyers says that when trainers ask doctors to come up with a list of words describing their initial response to mental health, fear is always at the top of the list. “The good news,” he says, “is that by the end of the week, we ask the same question and that’s all gone.”

Conclusion

Lesotho, just like any country, has its own unique set of stressors and difficulties. Fortunately, organizations such as Dolen Cymru and Help Lesotho are going to great lengths to provide Lesotho with the assistance it needs. However, there is definitely still work to be done.

– Kimber Peters
Photo: Pexels

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Diseases Impacting Albania

Diseases Impacting AlbaniaWhen it comes to the right to health, Albania is achieving 66.3% of what it should based on its income level, according to the Human Rights Measurement Initiative. This estimate measures preventative and reproductive health care, health rehabilitation, the right to health for children and adults and disease control. As for the latter category, several diseases are impacting Albania.

Top Causes of Death in Albania

The World Health Organization (WHO) finds that from its 2.9 million population, these are the most prominent causes of death per 100,000 people in Albania as of 2019:

  • Stroke (378 deaths in women and 235 in men)
  • Ischaemic heart disease (338 deaths in women and 274 in men)
  • Alzheimer’s disease and other dementias (93 deaths in women and 34 in men)
  • Chronic obstructive pulmonary disease (17 deaths in women and 33 in men)
  • Lower respiratory infections (24 deaths in women and 20 in men).

All the current deadliest diseases impacting Albania fall under the non-communicable category. However, a 2011 study also found a 19% prevalence of intestinal parasitic infections (IPI) among Albanian children. Though not as impactful to the overall population as their non-communicable counterparts, it is worth noting that infectious diseases are a category Albanians are susceptible to as well.

One of the most prominent communicable diseases impacting Albania is HIV, a viral sexually transmitted disease that leads to AIDS. According to the Joint United Nations Programme on HIV/AIDS (UNAIDS), the number of Albanian adults and children living with HIV as of 2022 was approximately 1500. Of this estimate, less than 500 were women aged 15 and above and 1000 were men of the same demographic. That same year, less than 100 Albanian adults died and less than 500 children from 0 to 17 became orphans due to AIDS.

The Good News

Despite statistics depicting that the government needs even further work to address the rate of diseases impacting Albania, the country has seen significant improvements in the health department. The life expectancy at birth in Albania as of 2021 is 76, a 2.5-year improvement from what it was in 2000. Similarly, the percentage of children under a year old receiving the measles vaccine is 86 and the total population receiving all eight basic vaccines is 75.

Initiatives and Solutions

Even with the substantial estimate of Albanian adults and children living with HIV, 31.72% of young people aged 15 to 24 are knowledgeable about HIV prevention. The coverage of adults and children receiving antiretroviral therapy is even higher, estimated at 57%.

The organization Aksion Plus takes credit for this step. Founded in 1992, Aksion Plus is a volunteer group that aims to stop the spread of HIV/AIDS in Albania through four main objectives:

  • Raising awareness through peer education: A team of social workers provides educational tools and counseling in high schools about HIV/AIDS prevention and reproductive health.
  • Advocacy: Aksion Plus uses advocacy and capacity building to influence policymakers on HIV/AIDS, as well as deliver training sessions to teachers, students, police officers, health practitioners and caregivers.
  • Research: Cooperation with organizations like UNICEF, WHO and the Institute of Public Health enables the foundation to research and evaluate HIV/AIDS statistics in Albania.
  • Treatment for vulnerable groups: Aksion Plus implements several programs to provide treatment to drug users or sex workers. Such programs include “The Center for Harm Reduction and Resource Center,” which focuses on harm reduction, advocacy and promoting healthy lifestyle education for drug users.

With the support of WHO, Albania also established a cross-sector national program on the prevention and control of non-communicable diseases (NCDs). Since its development in 2017, the program has aimed to reduce health inequalities, introduce NCD prevention programs and implement health care to maximize population coverage.

Health for All Program

Another program that tackles the NCD burden in Albania is the “Health for All Program” (HAP). In addition to assisting with the development of the “National Health Promotion Action Plan,” HAP has also helped support health literacy and promotion in the country through a variety of approaches:

  • Media campaigns: A November 2017 campaign on diabetes awareness accumulated 88,000 viewers.
  • Health promotion in schools: More than 600 children, their parents and 57 teachers participated in the “Health Promoting Schools” initiative, which provides guidance and information on sports and healthy eating in schools. The initiative also hosted nutrition fairs in Dibër.
  • Hypertension awareness and control: In 2018, HAP partnered with local health centers to provide educational presentations on hypertension risk factors and blood pressure screenings to several municipalities and the cities of Tirana and Durrës. The attendance estimate was 7,058 community members.

Such statistics highlight the meaningful progress the government and NGOs have made in addressing and combating the rate of communicable and non-communicable diseases impacting Albania.

– Jay Kosumi
Photo: Flickr

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HIV/AIDS in Trinidad and Tobago

HIV/AIDS in Trinidad and TobagoIn the past three decades, HIV/AIDS in Trinidad and Tobago has been a defensive battle. In 1983, there were only eight registered cases of AIDS, however, a mere nine years later, Trinidad and Tobago ranked 17th out of 164 countries in reported cases per 100,000-person population.

National Planning

Alongside the Caribbean as a whole, Trinidad and Tobago began its work towards HIV/AIDS prevention. Multiple programs and national policy created noticeable positive changes in the spread of the virus as well as preventative testing and general education. The country’s HIV and AIDS coordinating committee implemented the National HIV/AIDS Strategic Plan in 2004. The plan incorporated youth empowerment programs, voluntary counseling, preventative testing and specific prevention of mother-to-child transmission. The government launched free antiretroviral treatment to manage infection for those who acquired the virus congenitally. This program led to dramatic decreases in the number of mother-to-child-related transmissions.

The island’s National Prevention and Control Program most recently created the National HIV/AIDS Policy 2020-2030. The policy places focus on key vulnerable populations at risk of infection. To achieve an end to HIV/AIDS in Trinidad and Tobago by 2030, the National AIDS Co-ordinating Committee (NACC) created objectives that include “universal access to comprehensive HIV prevention services/ programs/ interventions, an increased proportion of the population living with HIV that knows their status, increased coverage of testing, a decreased population that engages in risky sexual behaviors and increased use of technology in HIV prevention.”

UNICEF Support

In 2009, UNICEF brought support to the island’s fight against HIV and AIDS. An educational program “Kicking AIDS Out” began in Speyside by the Trinidad and Tobago Alliance for Sport and Physical Education. This organization uses games and sports to teach youth about the spread and prevention of HIV/AIDS in Trinidad and Tobago. Community members in that area of the country saw firsthand how AIDS can have a swift ripple effect. The increased testing and educated choices in the country’s youth made a noticeable impact on the amount of new HIV infections present within the population.

UNAIDS Regional Data

According to 2022 UNAIDS data, new infections of HIV have reduced by 15% in the Caribbean between 2010 and 2022 with stronger reductions among men. Virus-related deaths have decreased by 53% over the same time, yet are stronger among women. Sixty-three percent of the population living with HIV were on treatment in 2022 and 83% of the population living with HIV knew their status that same year. Antiretroviral therapy coverage increased from 19% to 63% among men since 2010, and from 21% to 74% among women.

Programs in place to prevent HIV transmission rose from 45% to 65%. However, these responses continue to rely on external sources. More than 70% of all available resources are received from international financing. According to UNAIDS, “transitioning to sustainable financing for HIV is crucial to build on the current progress and address the structural factors that limit access to services and increase HIV vulnerability in the region.”

Conclusion

These programs are creating positive change within Caribbean countries and Trinidad and Tobago specifically. By continuing to receive support from organizations such as UNAIDS and UNICEF, Trinidad and Tobago could potentially stop the spread of HIV and AIDS.

– Chloe Landry
Photo: Flickr

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A Progress Report on HIV/AIDS in Benin 

HIV/AIDS in Benin According to the CIA World Fact Book, the Republic of Benin is a small, low-income, multi-ethnic country in West Africa. Benin borders Nigeria to the east, Niger and Burkina Faso to the north, Togo to the west and the Atlantic Ocean to the south. Benin was a French colony until it gained independence in 1960. The Kingdom of Dahomey occupied present-day Benin before colonization. Benin has been on the front lines of the HIV/AIDS epidemic since the 1980s.

Significant Progress Has Been Made on HIV/AIDS in Benin

UNAIDS data shows the total number of Beninese people living with HIV/AIDS was 72,000 in 2022, down from a high of 77,000 in 2014. The World Bank put these numbers into percentages. In 2021, 0.8% of Benin’s population was living with HIV/AIDS, a 0.7% decline from the 1.5% peak in 2001. 

UNAIDS announced that half of adults with HIV/AIDS in Benin were on antiretroviral treatments in 2017. That percentage increased to 81% in 2022. New annual HIV infections in Benin plummeted from 8,600 in 1996 to 1,800 in 2022. Similarly, AIDS-related deaths fell sharply, from 6,100 in 2007 to 1,900 in 2022. UNAIDS will continue to implement community-focused approaches to improve access to care, reduce transmission and end discrimination against Beninese people infected with HIV. 

Fighting HIV/AIDS Reduces Poverty

A 2005 report from the International Labour Office and UNAIDS explains the link between HIV/AIDS and poverty. HIV/AIDS infections have an outsized impact on household, local and national economies. HIV infections can make people too ill to work. Families often have to drain their savings to pay for medical care and fill in for missing income. Children may need to take time off school to care for an infected parent or work. Missing school has a significant impact on long-term economic livelihood. Data indicate that high rates of HIV/AIDS infections slow economic growth and reduce the size of the labor force. The report argues that countries that are an exception to this trend may have implemented a more organized response to the HIV/AIDS epidemic.

Interventions for Sex Workers

Research published in 2012 by S. Baral and others in the journal Lancet Infectious Diseases found female sex workers (FSW) and their clients to be focal points of HIV/AIDS in Benin. In a 2013 study by L. Béhanzin and others published in the National Library of Medicine, researchers focused their FSW-targeted interventions on three fundamental areas:

  • Community: Improving HIV/STI knowledge, condom education and negotiating skills to promote condom use with clients
  • Clinical: Monthly check-ups and free STI testing for FSW
  • Structural: Working with the police and FSW managers to reduce harassment and violence directed at FSW

The HIV/AIDS rate among FSWs in Benin who received the interventions declined from 53.3% in 1993 to 30.4% in 2008. According to UNAIDS, the infection rate among sex workers was 7.2% in 2022, and condom use was at 90.4%. Researchers also speculate that these interventions may have reduced the spread of HIV/AIDS in Benin outside the FSW and client populations.

Planning for the Future

HIV/AIDS in Benin is a significant and continuing public health and economic issue for the country. More work is necessary to reduce the total number of people living with HIV/AIDS. However, targeted and effective interventions have reduced the spread of HIV/AIDS in Benin over the last several decades, especially among vulnerable populations. Fewer people living with HIV/AIDS means more labor force participation, household savings, economic development and kids in school. Overall, HIV/AIDS programs in Benin have a positive economic impact and reduce poverty in the country.

– Joey T. McFadden
Photo: Unsplash

HIV/AIDS in Cuba

HIV/AIDS in CubaAccording to UNAIDS, in 2022, 42,000 people lived with HIV/AIDS in Cuba. Although the disease has claimed many lives since its discovery and initial cases, the threat has reduced significantly through Cuba’s handling of the pandemic. “Cuba’s national AIDS program is the most successful in the world based solely on statistics,” according to a research article by Sarah Z Hoffman published in 2004.

The First Cases

Cuba noted its first case of HIV/AIDS in 1985 — a heterosexual male returning from travel abroad. The country’s leading infectious disease specialist, Dr. Jorge Perez, spearheaded a drastic approach to contain the spread by destroying all foreign-sourced blood products while also commissioning a National AIDS foundation before the first reported death of AIDS in 1986. Cuba’s strategy continued to differ drastically from many countries, with many of its protection regulations already being sanctioned and declared lawful through existing health regulations. Decree-Law 54 for example, stated for the prevention of such diseases, individuals suspected of suffering from a communicable disease would be subject to immediate isolation and quarantine from the public and potentially infected individuals would need to suspend or limit their daily activities.

The Strategy

While many view Cuba’s approach to the pandemic as barbaric or controversial, Cuba’s stratagem has been the most effective in the world based on statistics. The United States caseload of HIV/AIDS infected persons was 10 times higher than Cuba, which had reported 1,177 back in 2003. In July 1983, the Ministry of Public Health in Cuba published an article stating that the Ministry itself would oversee the determination of which diseases pose a risk to the community as well as the adoption of diagnostic and preventative measures to contain the spread of the outbreak, reduce transmission and present options for mandated treatment.

From 1986 to 1994, the Cuban Government utilized these regulations to lawfully quarantine HIV-positive individuals in sanatoriums built and maintained by the Ministry. While these facilities were isolated from the general populace, the sanatoriums provided food, shelter, medication and education on the dangers of contraction and the importance of honesty, healthy behaviors and safe sex practices. The Cuban government rescinded this law in 1994 and relaxed mandated isolation protocols. However, the government required persons testing positive for HIV/AIDS to stay in a sanatorium for approximately eight weeks to receive thorough education on the disease. The government permitted people who completed their eight-week programs to leave and allocated a general care physician to help each person manage their conditions.

Today

Every year, a total of 1.4 million mothers living with HIV become pregnant. While untreated, they risk a 15-45% chance of transmitting the infection to their infant during pregnancy, labor or breastfeeding. Since 201, the WHO (World Health Organization) has partnered with Cuba and other countries in the Americas to implement a region-wide system that will virtually eliminate mother-son transmission of HIV and syphilis. This effort is achieved through rigorous HIV testing for both pregnant women and their partners. Cuba’s nationwide health care access makes this easy for mothers who may test positive to receive treatment and education to continue their daily routines without fear or transmission.

According to PAHO Director Dr. Carissa Etienne; “Cuba’s success demonstrates that universal access and universal health coverage are feasible and indeed the keys to success. Even against challenges as daunting as HIV.” In 2014, The WHO and supporting partners published an article titled “Guidance on global process and criteria for validation of elimination of Mother to Son transmission of HIV and Syphilis,” which outlined the requirements and the specificity of different indicators each country needed to meet to validate such elimination.

The Lesson

While many have critiqued Cuba’s HIV/AIDS management strategy, Cuba’s stratagem has been unlike any other implemented across the globe, with almost unprecedented results. As of today, only one sanatorium remains open. With quarantine and isolation laws no longer in place, the remaining sanatorium has become a hospital and a clinic for those who seek extensive HIV treatment by their own choice. With global health care, worldwide attention and universal access to everyone, the world can win the fight against HIV/AIDS. Everyone can be helped and everyone can be treated, regardless of financial means or societal status.

– Anthony Durham
Photo: Flickr