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Doctors Without Borders

Nonprofit medical aid conglomerate Doctors Without Borders, or Medecins Sans Frontieres, requests increased access to treatment for Western and Central African countries. Although not the highest-risk demographic, less than one-third of the afflicted receive life-saving medicines.

Eastern and Southern Africa hold half of the world’s HIV-infected population. As a result, intervention, prevention and treatment overwhelmingly pour into this region of the world, leaving others without equitable aid. Dr. Cecilia Ferreyra, HIV adviser for Doctors Without Borders, reports that in the last five years, “the number of people on life-saving HIV treatment worldwide doubled.” Yet, 4.5 million people in Western and Central Africa do not receive treatment.

The plea from the organization came a day before an important U.N. meeting discussing the prevention of AIDS. On June 10, a U.N. press release indicated the member states would implement a bold course of action to end AIDS as a public health threat by 2030. With a goal like this, areas of concern can now be reached with renewed vigor.

It seems Doctors Without Borders has been effective in lobbying the UN for increased attention to regions with a lower HIV prevalence. In the press release, UNAIDS stated, among its other goals, that it would set “an action agenda for getting to 90-90-90,” referring to the percentage of people who know their HIV-positive status, receive antiretroviral treatment and reach viral suppression. Its goals also promise UNAIDS will be “leaving no one behind” in the quest to completely eliminate AIDS.

The U.S. specifically has committed to introducing a $100 million Key Populations Investment Fund that is intended to bridge the gap between PEPFAR and those who don’t normally receive financial help. It aims to assist people facing discrimination, such as sex workers, gay men, intravenous drug users, transgender people and prisoners. This could help regions like Western and Central Africa in which stigmatization prevents those with HIV from receiving proper treatment.

Despite the region-specific challenges faced by Western and Central Africa—which (besides stigma) includes a shortage of well-trained medical staff, service shortcomings and high fees—the spread of HIV/AIDS is certainly slowing. The goal of ending AIDS by 2030 encompasses the entire globe, not just the areas in dire need.

Connor Borden

Photo: Flickr

fast-track approach to ending AIDS
From June 8 to 10, the UN General Assembly held the High-Level Meeting on Ending AIDS in New York City to draft a new Political Declaration on Ending AIDS and to introduce the Fast-Track approach to ending AIDS.

The Fast-Track approach to ending AIDS plans to increase and front-load investments in fighting the AIDS epidemic. This would be done in combination with scaled up coverage of HIV services in order to reduce the rate of new infections and AIDS-related deaths.

Greater investment in human rights, advocacy, civil society and community-based services are also essential to the Fast-Track approach, according to meeting documents.

The ultimate goals of the Fast-Track approach to ending AIDs are to ensure that fewer than 500,000 people are newly infected with HIV, to ensure that fewer than 500,000 people die from AIDS-related illnesses and to eliminate HIV-related discrimination.

UNAIDS, the branch of the UN working towards “zero new HIV infections, zero discrimination and zero AIDS-related deaths” as part of the Sustainable Development Goal of ending the AIDS epidemic by 2030, said in a press statement that it wanted to hear from both individuals living with HIV and NGOs helping people on the ground during the meeting.

One such group is AIDS Outreach, an NGO located in Montana. Executive Director Bob Cruz said in an interview that most of his time is spent testing for HIV. His next biggest challenge is ensuring that those who test positive for HIV find an insurance package they can afford.

“Treatment is out there, but to get [people living with HIV] on it we need to know what insurance options are available,” Cruz said. “There are many, but they don’t know it.” According to Cruz, treatment for HIV can cost $3,000 to $4,000 per month.

In Secretary General Ban Ki-moon’s report, “On the fast track to ending the AIDS epidemic,” he noted that he has spoken with individuals about their difficulties obtaining the retroviral medicine they need.

Although past successful policies have extended access to retroviral treatment, the UN General Assembly’s zero draft political declaration states that people living with HIV “in low- and middle-income countries still remain without treatment.”

The declaration goes on to say that “a substantial proportion of people on antiretroviral therapy face social and structural barriers to good health, including lack of social protection, care and support and as a result struggle to adhere to their treatment.”

Until a recent funding cut, AIDS Outreach had offered support groups for people living with HIV and for men who have sex with men, a key population affected by HIV. Before the cut, Cruz said the groups gave people a sign of visible support. Their purpose was “to offer someone a space to talk about what is on their mind,” free of judgment.

If Cruz had more resources, he would restart AIDS Outreach’s support groups and put more time into educating people in schools and prisons. He would also want to ensure that people knew more about recent advancements in treatment, helping to reduce the fear and stigma of living with HIV.

According to Cruz, new treatments such as PrEP, a drug that people at very high risk for HIV take daily to lower their chances of getting infected, allow people to live without the constant fear of their immune system becoming compromised.

At the High Meeting, the zero draft political statement said that health needs must be addressed in a more holistic manner. The UN will not only work to ensure the health and wellbeing of people living with HIV, but also “health security, universal health coverage and health system strengthening and preparedness.”

As part of the greater investment in HIV prevention and treatment, and to provide more holistic treatment, key areas are in need of more resources.

According to meeting documents, community mobilization needs to rise to three percent of total HIV investment by 2020—three times the current amount. Investment in social enablers, such as advocacy, law and policy reform and stigma reduction, needs to rise to eight percent of total investment by that time.

In 2014, there was $19 billion available that had been invested in the prevention and treatment of HIV. Meeting documents stated that this needs to increase to $26 billion available annually by 2020.

It is hoped that this increased investment, along with better service coverage and a more efficient use of resources, will lead to the success of the fast-track approach to ending AIDS, resulting in declining annual resource needs after 2020.

Anastazia Vanisko

Photo: Flickr

 

UNAIDSUNAIDS and United States President’s Emergency Plan for Aids Relief (PEPFAR) collaborated with faith-based organizations (FBOs) in East Africa to launch a two-year initiative to strengthen their capacity to respond to HIV.

On Sep. 15, 2015, in the seventieth session of the United Nations General Assembly in New York, it was revealed that the five focus areas of the U.S. $4 million program are: collecting, analyzing and disseminating data; challenging stigma and discrimination; increasing demand for HIV services and retaining people in care; improving HIV-related service provision; and strengthening leadership and advocacy.

This new program is the result of suggestions made by faith leaders at a deliberation in April 2015. The conference hosted over 50 faith leaders from Kenya, Rwanda, Uganda and the United Republic of Tanzania.

The faith leaders called for more access to data, heightened accountability and better collaboration between FBOs and international partners.

The report, Building on Firm Foundations, which was released by the United Nations General Assembly, UNAIDS, PEPFAR and Emory University last month, highlights the impact of faith-based responses to epidemics in the four East African countries.

FBOs provided a majority of health services and sustained collaborative communities which maintain a disease-free environment for future generations.

PEPFAR’s partnership with FBOs has allowed them to reach 7.7 million people with lifesaving antiretroviral treatment, and treat 14.2 million pregnant women, thus decreasing mother-to-child transmission of HIV.

The recently launched PEPFAR 3.0 – Controlling the Epidemic: Delivering on the Promise of an AIDS-free Generation set the ambitious goal of 90-90-90.

By 2020, PEPFAR aims to achieve: 90% of people living with HIV who know their status, 90 percent of people who know their status and are receiving treatment and 90% of people on HIV treatment who have a suppressed viral load.

Thus it is important to strengthen partnerships with FBOs, as they are primary health providers for many communities, and allow UNAIDS and PEPFAR to expand their impact.

Luiz Loures, UNAIDS Deputy Executive Director, stated that “Faith-based organizations are essential partners, particularly in the areas of health service delivery and addressing stigma and discrimination. The partnership with faith-based organizations is critical to ending the AIDS epidemic and making sure that no one is left behind.”

Marie Helene Ngom

Sources: UNAIDS, PEPFAR Report
Photo: Flickr

UNAIDS Wants Trade Agreements to Uphold Commitments to Public HealthWith the celebration of reaching 15 million people with HIV treatments and committing to end the AIDS epidemic, UNAIDS reminds countries that new trade agreements should not limit access to medicine.

At the 2011 Political Declaration on HIV/AIDS, governments reconfirmed their commitment to the use of existing flexibilities under the Trade-Related Aspects of Intellectual Property Rights (TRIPS). Specifically, governments reiterated their commitment to promoting access and trade of medicines and to ensure that intellectual property rights provisions in trade agreements do not undermine existing flexibilities.

TRIPS had to be reestablished with governments because as explained by UNAIDS Executive Director, Michel Sidibé, “We are entering a crucial phase of the AIDS response which will decide whether we end the epidemic as a public health threat by 2030. Anything that undermines that response must be avoided.”

Trade negotiators from 12 countries are working to conclude the Trans-Pacific Partnership Agreement (TPP). Under this text, there are reportedly provisions that go beyond what is required under the TRIPS Agreement.

With these “TRIPS-plus” provisions, generic competition could become more difficult. This would lead to higher drug prices. “Generic competition in the pharmaceutical industry, as well as the use of intellectual property flexibilities, have helped make prices for life-saving drugs much more affordable and enabled the unprecedented scale up of HIV treatment programmes.”

To achieve the elimination of AIDS by 2030, treatment drugs should not become more expensive. Instead, testing and medications should become more abundant and affordable to individuals.

The Fast Track Initiative not only wants to treat individuals who are infected with the virus but prevent the further spread of infection. With the combination of treatment and spreading awareness, this is how AIDS will be eliminated.

With this initiative, 28 million HIV infections will be avoided between 2015 and 2030. Twenty-one million AIDS-related deaths with be avoided during that same time period. A main point in this initiative is that the billions of dollars spent on HIV treatment will be made available to be spent on other areas of health care.

Early testing and treatment of HIV will save a generation that may not even be aware that they are infected. With many African countries being plagued by the spread of HIV, informing people about treatment and options is one of the best ways to end AIDS.

If the global Aids response is to attain the 90-90-90 treatment target by 2020 — 90 percent of people living with HIV knowing their status, 90 percent of people who know their status on treatment, and 90 percent attaining viral suppression — HIV treatment must be accessible and scale up must be financially sustainable.

Kerri Szulak

Sources: UNAIDS 1, UNAIDS 2
Photo: Flickr

Transgender Population and HIV: Uncovering Problems
HIV is one of the few viruses to completely alter the landscape of the entire world as a whole. Not since great pandemics such as the Black Death has a sickness decimated families, communities and nations like HIV has.

HIV does not discriminate. The virus infects people from all walks of life: Muslims, Christians and Atheists; Blacks and whites; males and females; even the old and the young. Likewise, to combat HIV, the world needs to fund prevention programs just as indiscriminately.

From the misconceptions as an exclusively homosexual disease to the unity the world has made in dealing with it, one thing is for certain—HIV is still present and must be eliminated.

HIV strategies have been largely successful in combating HIV and preventing AIDS from infecting people at staggering rates. According to UNAIDS, in 2014, 2 million new infections of HIV were recorded. This was down 35 percent from the year 2000 when that number was reported at 3.1 million new infections.

The overall HIV and AIDS mortality rates have also fallen over the course of 15 years. A total of 36.9 million people worldwide are living with HIV, and 1.2 million have died from AIDS. That is down from 2 million in 2005. Almost half the current HIV population is taking antiretroviral therapy (15 million). Currently, $20.2 billion is invested in the AIDS response, right on target of expected funding required at $22 billion.

There is, however, one group of minorities who are of a great deal of concern. They are transgender people. They represent a group of people with the most imbalance of all infected groups.

According to the most comprehensive WHO report on transgenders to date, transgender women have 49 times higher odds of HIV infection than the general population. Among sex workers, transgenders have nine times higher odds of contracting HIV compared to female sex workers.

The imbalance has many factors behind it. They are the largest under-served community when it comes to HIV prevention. This is due to marginalization, lack of access to proper treatment for many mental health-related issues, grouped with homosexuals in prevention tactics and also being a target of violence.

Transgender individuals face many social issues in society. While some may be well off, many transgenders work low-paying jobs due to a lack of equal opportunities for employment. Stigma and discrimination cause many to turn to drugs and sex work as a means of making money.

That lifestyle can lead to many health risks, including drug abuse, homelessness and the lack of access to adequate medicines. Many transgenders also face discrimination when they attempt to receive medical treatment from healthcare workers. It makes them more susceptible to infection.

Another problem is the lack of countries properly defining what gender a transgender person is. Many countries consider transgender sex the same as homosexual behavior. Anti-homosexual laws make transgenders fearful, hiding their infections for fear of death or incarceration. Some fear carrying condoms, as they may be used against them to confirm illicit behavior by law officials.

Inadequate training among healthcare workers to transgender-sensitive issues leads to misdiagnosis and mistrust.  The negative discrimination mentioned also decreases the quality of care they receive. Coupled with the general stigma, this creates a vicious cycle that is not helping with HIV prevention measures.

Transgenders are also vulnerable to higher degrees of violence and rape. There are no feasible studies to measure the number of rapes and murders transgenders experience due to misreported gender identity. Rape victims may contract HIV and not report it due to fear of retaliation.

All these problems have led to poor results in HIV prevention amongst transgender populations in the world. The issue is crucial in the fight against AIDS because some transgender people may have sexual partners with both males and females, making more people susceptible to spreading HIV. The global effort to combat AIDS must include all types of people around the globe.

The next part of this article will demonstrate working solutions and how continuous funding will help reduce HIV.

Adnan Khalid

Sources: UNAIDS, World Health Organization
Photo: HIV Plus Mag

The Threat of a Major AIDS Resurgence
Is AIDS on the rise despite the increase in HIV treatment availability throughout the world? A recent report by the Joint U.N. Programme on HIV/AIDS (UNAIDS) and The Lancet, a medical journal, have called attention to the emerging risk of a major AIDS resurgence in already affected regions.

According to the study, high rates of population growth in heavily affected areas and staggering infection rates, which continue to only fall slowly, will increase the number of people who need access to life saving treatment.

Director of the London School of Hygiene & Tropical Medicine and lead author of the report, Professor Peter Piot, stated, “We must face hard truths — if the current rate of new HIV infections continues, merely sustaining the major efforts we already have in place will not be enough to stop deaths from AIDS increasing within five years in many countries.”

Among the most vulnerable populations, women and girls have not reaped the same benefit from slowly falling infection rates in comparison to their male counterparts. According to UN News Centre, AIDS-related illnesses are the leading cause of death for Sub-Saharan woman and girls of reproductive age.

The population of HIV-positive adolescent girls reaches sevenfold that of males. Additionally, many adolescent girls become infected with HIV 5 to 7 years before men.

In a commitment to prevent new HIV infections and increase treatment among women and girls, UNAIDS and the African Union have come together in a report called “Empower young women and adolescent girls: Fast-Track the end of the AIDS epidemic in Africa”.

“As we work with our communities, our networks, our health service providers and our governments, we must commit to demanding a comprehensive focus on young women in the AIDS response,” said Rosemary Museminali, UNAIDS Representative to the African Union.

In this response lies the answer to the threat of resurgence. As the study argues, efforts to combat AIDS must be enhanced to proportionally treat those infected, improve knowledge and prevention, and provide better access to medication.

More recently, the United Nations sponsored a successful deal with Roche Diagnostics in order to reduce the price of early infant diagnostic technology by 35 percent to US$9.40. Early diagnosis of HIV is essential to accessing treatment at a vital stage since many children who go undiagnosed only live up to 2 or 5 years.

“We have to act now,” Michel Sidibé, executive director of UNAIDS cautions, “The next five years provide a fragile window of opportunity to fast-track the response and end the AIDS epidemic by 2030. If we don’t, the human and financial consequences will be catastrophic.”

– Jaime Longoria

Sources: UNAIDS, UN News Centre 1, UN News Centre 2, UN News Centre 3

Photo: HealthNest

HIV_treatment
The Food and Drug Administration will approve a new, antiretroviral formula of HIV and AIDS treatment for children, declared UNAIDS and UNICEF on June 5, 2015.

Within the first few weeks of approval, the first batches of the new drug will be shipped to Kenya. Organizations such as Drugs for Neglected Diseases initiative will begin to introduce the formula to local communities to improve the health of children right away, said Dr. Marc Lallermant, head of DNDi’s Pediatric HIV Program.

The pioneer formula can be mixed with food, which makes it easier for children to consume. It is also heat-stable, meaning it does not require refrigeration, and it is more palatable than the drug that is currently available.

The current drug comes in the form of a pungent, unappetizing syrup that is 40 percent alcohol. This harsh formula is difficult for young children to consume. The circulating formula also requires refrigeration, which inhibits treatment in poor areas that do not have electricity or access to refrigeration.

Though the number of children receiving AIDS and HIV treatment has increased from 70,000 in 2006 to 760,000 today, thousands of children remain without treatment. In fact, only one in four infected children are being treated. Today, 3.2 million children live with HIV, and fewer than 800,000 of them are receiving treatment.

“This new formulation is a step in the right direction towards saving more lives of children living with HIV. We expect it to greatly improve treatment access for many more children and support UNICEF’s equity-focused programming aimed at reaching the most disadvantaged children throughout the world,” said Craig McClure, UNICEF’s chief of HIV and AIDS Programs.

If antiretroviral treatment begins early in infected children, according to the World Health Organization’s recommendations, the risk of death is greatly reduced. HIV progresses rapidly in young children.

In many impoverished countries with a greater amount of infected children, HIV is a major contributor to child morbidity and mortality. UNAIDS said, “Without treatment, one in three children who become infected with HIV will die before their first birthday. Half will die before their second birthday.”

The FDA’s approval is to come soon, as an intellectual property issue surrounding who is able to access the new formulation has been resolved. The Medicine Patent Pool signed with AbbVie, the patent holder for the new formula, in December of 2014. “This is a crucial license for pediatric programs as it benefits low- and middle-income countries where 99 percent of children with HIV in the developing world live,” said Greg Perry, executive director of the MPP.

In the future, the organizations UNITAID, DNDi and Cipla aim “to develop two ‘4-in-1’ fixed-dose combinations of Lopinavir/ritonavir with other key antiretroviral components (zidovudine/lamivudine and abacavir/lamivudine) that are recommended by the World Health Organization,” said Medical News’ website. The completely taste-masked version beyond the new pellet will allow for even more access for children with HIV.

– Margaret Anderson

Sources: FDA, News Medical, U.N. AIDS
Photo: Doctors Without Borders

world_aids_day
As World AIDS Day 2014 fast approaches, organizations strive to promote awareness and support for the cause. Led by groups such as the World Health Organization, World AIDS Day takes place on December 1 each year. This year’s campaign aims to promote social change and focuses on closing the access gap to important treatment.

Over 39 million people have lost their lives to HIV over the last few decades, and an estimated 35 million people were living with the disease in 2013. World AIDS Day is intended to pay homage to those who have died while advocating awareness and support for an HIV-free future.

The 2014 campaign asserts that closing the gap in HIV testing accessibility would help 19 million unknowingly affected people receive care and support. Additionally, the 35 million HIV-positive people across the world would gain access to vital medicine.

The campaign also aims to allow for children to receive better access to HIV treatment, as currently only 24 percent are able to receive care.

Organizations declare that by closing the access gap, the world could see an end to the AIDS pandemic by the year 2030.

The WHO plans to honor World AIDS Day by releasing new information and recommendations to assist countries in their progress toward HIV prevention and treatment. The new WHO guidelines will cover recommended use of antiretroviral drugs for those that have been exposed to HIV including healthcare professionals, sex workers and rape victims. The manual will also include information regarding the treatment of infections and diseases that can be detrimental to HIV patients.

For the last several years, the WHO has been a strong advocate of antiretroviral, or ARV drug treatment for HIV infections. The latest statement reported, “The ARV regimens now available, even in the poorest countries, are safer, simpler, more efficacious and more affordable than ever before.”

As World AIDS Day approaches, many are showing their support for the cause and the 2030 virus-free goal. Leader of the U.S. National Institute of Allergy and Infectious Diseases, Anthony Fauci, states, “With collective and resolute action now and a steadfast commitment for years to come, an AIDS-free generation is indeed within reach.”

However, WHO officials urge that there is still a great deal of work to be done in order for these treatments to become accessible to communities in need. Officials hope that the new HIV guidelines will help to close the gap in prevention and treatment for everyone affected.

In honor of World AIDS Day 2014, many companies are providing special offers that allow for proceeds to go toward the fight against AIDS. The (RED) campaign has partnered with businesses including the Apple Store, Starbucks, CocaCola, Bank of America and many more to raise awareness and gain support for the cause.

Getting involved this holiday season, either by participating in the campaign or helping as a consumer, can make an enormous difference in the future of our world.

– Megan Douches

Photo: World Aid Day UN AIDS, WHO
Photo: Flickr

HIV/AIDS
Sex workers, along with other marginalized groups, are at high risk for contracting HIV/AIDS due to a multitude of reasons. The levels of risk vary greatly from country to country, depending on whether they work on the “streets” and have access to contraceptives, among other things. Even within countries, there can be great variance with the rates of HIV/AIDS. In Mumbai, India, sex workers have a HIV/AIDS prevalence of 4.6 percent, whereas brothels in Maharashtra have a rate of 29 percent. No matter the diversity, sex workers all over the world share common obstacles that increase their exposure to HIV/AIDS.

A sex worker usually has an extremely high number of sexual partners. If condoms are used consistently, then transmission of the disease is diminished, but that is not likely to be the case abroad. The 2010 UNAIDS global report found that only a third of the 86 countries researched reported 90 percent of workers using condoms with their last client. In many instances, sex workers lack access to condoms or are not aware of their importance. Moreover, many sex workers are not able to negotiate condom use, because it can mean he or she will be paid a lesser amount.

In addition, laws in many countries do little to protect sex workers, often ostracizing them from society. Although sex work can be partially legal in a few countries, legislation and policies do not punish the action of clients that can put these sex workers at risk for HIV/AIDS. For instance, a sex worker who has been raped will most likely be unsuccessful in taking the perpetrator to court. The lack of protection in these cases puts sex workers at very high risk of getting HIV/AIDS.

Despite all of this, there has been progress in places like Nairobi, Kenya, where women are taking charge of their own fate. Viviane Muasi, a female sex worker, is a peer educator with the Sex Workers Outreach Progamme. When she is not working at night, she spends most of her time advocating for HIV testing and consistent condom use. SWOP, run by the University of Nairobi and Canada’s University of Manitoba, has enabled over 3,000 women to get tested for a variety of sexually transmitted infections, including HIV/AIDS. During the clinic visits, medical staff hands out prevention packages to halt the transmission of HIV/AIDS. These packages include instructions for condom use, different family planning methods and treatment for sexually transmitted infections. Hopefully by promoting and supporting condom use and early detection, the rates of HIV/AIDS among sex workers will greatly decrease.

Leeda Jewayni

Sources: IRIN News, ADVERT
Photo: BAM

aids epidemic
Recent statistics released in a new report by UNAIDS show that the number of new HIV/AIDS cases have been decreasing steadily. This new data shows that for every 10 percent increase in treatment coverage, there is a one percent decline in new infections among those living with HIV. However, the report also noted that far more international effort was needed because this current pace is insufficient to completely end the AIDS epidemic.

In 2013, 2.1 million new HIV/AIDS cases were recorded, down from 3.4 million new cases in 2001. 2013 also saw an additional 2.3 million people gain access to the life-saving antiretroviral therapy (ART), which is a drug that substantially suppresses many of the symptoms of AIDS and increases life spans. This means that a grand total of 13 million people have previously had or currently have access to ART. AIDS-related deaths have fallen by one-fifth in the past three years.

The most headline-grabbing piece from the report came from Michael Sidibé, Executive Director of UNAIDS, who said, “If we accelerate all HIV scale-up by 2020, we will be on track to end the epidemic by 2030.”

However it is important to know that while there has been significant improvement, considerable work still needs to be done. Sidibé went on to say that if we don’t continue to scale up efforts, then we would “[add] a decade, if not more” to the 2030 goal.

Only 15 countries account for more than 75 percent of the 2.1 million new HIV infections in 2013. In Sub-Saharan Africa the countries of Nigeria, South Africa and Uganda account for 48 percent of all new HIV infections in the region. Fewer than four in 10 people currently with HIV lack the ART necessary to survive. HIV prevalence is estimated to be 12 times higher in sex workers, 19 times higher among gay men, 28 times higher in drug injectors and up to 49 times higher among transgender women. Sub-Saharan adolescent girls and young women account for one in four new HIV infections.

While there are a tremendous amount of fascinating statistics on the matter, it’s important to not get lost in them. This new report from UNAIDS shows that progress is being made, but an even stronger effort is needed in order to end the AIDS epidemic in a timely fashion and save millions more lives.

Andre Gobbo

Sources: BBC, UNAIDS 1, UNAIDS 2
Photo: New America Media