HHS commits nearly $1.8 million to health initiatives in Guatemala and to improving global human research protections

News Release. January 10, 2012. The U.S. Department of Health and Human Services will invest approximately $1.8 million to increase its efforts to improve the treatment and prevention of HIV and other sexually transmitted diseases (STD) in Guatemala and to further strengthen ethical training on human research protections.  Building on existing work by HHS agencies, these new activities are part of the Obama Administration's commitment to ensuring that the United States has the strongest possible human subject protections at home and around the world.

The Centers for Disease Control and Prevention will expand its current investment that supports the Guatemalan Ministry of Health and Social Assistance’s (MSPAS) strategy to improve surveillance and control of HIV and other STDs among at-risk populations in Guatemala.  CDC supports approximately 60 percent of the costs of the strategy and will increase that investment by $775,000 over three years. 

CDC support will assist MSPAS in expanding and updating national STD guidelines for diagnosis and treatment, strengthening the national surveillance system of STDs, and supporting laboratory diagnostic capacity. In Latin America, Central America is second only to the Caribbean as the sub-region most affected by the HIV epidemic. 

In addition, the National Institutes of Health is committing $1 million to support research that will be used to evaluate the impact of the revisions to the HHS regulations governing human subject research that are currently being considered.  Assessing the impact of the revisions that are ultimately implemented will be critical to the development of an evidence-based approach to ensuring the effectiveness of human research subject protections.  The U.S. government considers the protection of human subjects in research to be of paramount importance and requires all federally funded research on human subjects to adhere to the most stringent ethical guidelines.  There are currently numerous safeguards in place in the United States to prohibit these types of unethical practices, and the review of current regulations and standards is part of the administration's effort to ensure we have the best possible human subject protection in the United States and around the world.

CDC will improve public health investigators’ ethics training by updating existing epidemiology case studies, based on actual investigations involving research methods and ethical considerations. These case studies are included in the standard curriculum offered to all Field Epidemiology Training Program (FETP) residents.  Additionally, CDC is developing a case study that references specifics from the unethical research conducted in Guatemala in the 1940s by the U.S. Public Health Services. The case study will include learning objectives focused on the scientific and ethical issues in designing a field study, including components of a protocol, sampling strategy and sample size, informed consent in developing countries, developing an informed consent form, institutional review boards, and other scientific and ethical issues related to developing and conducting a field investigation.  Each year, approximately 400 to 600 new residents across 40 countries participate in CDC’s FETP training.

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Madagascar Second Multisectoral STI/HIV/AIDS Prevention Project

The Second Multisectoral STI/HIV/AIDS Prevention Project aims at supporting the Government of Madagascar's efforts to promote a multi-sectoral response to the HIV/AIDS crisis and to contain the spread of HIV/AIDS on its territory. 

In this context, and in line with the recommendations of the December 2008 mid-term review as well as the April and October 2011 supervision missions, the restructuring includes: (a) eliminating the Fund for STI/HIV/AIDS Prevention and Care-Taking which was not effective in delivering key interventions to target populations, (b) increasing the health sector response by scaling-up contracting with non-government organizations (NGOs) for delivery of services directly to target populations, and (c) strengthening monitoring and evaluation (M&E) including better aligning project activities to intermediate and outcome indicators. 

In addition, the project closing date will be extended by one year to December 31, 2012 in order to consolidate achievements and measure the results of proposed changes.

World Bank. Document Date:2011/12/23. Document Type: Project Paper. Report Number: 65780 

Main Report

Data Sheet

For more information about Projects in Madagascar see EASTERN AFRICA Projects

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Benin.Second Multisectoral HIV/AIDS Control Project

HIV/AIDS imposes enormous economic, social, health, and human costs and will continue to do so for the foreseeable future. The challenge is particularly acute in Sub-Saharan Africa, home to two-thirds (22.5 million) of the people living with HIV/AIDS globally, and where HIV/AIDS has become the leading cause of premature death. But now, after decades of misery and frustration with the disease, there are signs of hope. HIV prevalence rates in Africa are stabilizing. This book sheds light on these concerns by analyzing the fiscal implications of HIV/AIDS in Southern Africa, the epicenter of the epidemic. It uses the toolbox of public finance to assess the sustainability of HIV/AIDS programs.

Importantly, it highlights the long-term nature of the fiscal commitments implied by HIV/AIDS programs, and explicitly discusses the link between HIV infections and the resulting commitments of fiscal resources. The analysis shows that, absent adjustments to policies, treatment is not sustainable. But it also shows that, by accompanying treatment with prevention, and making existing programs more cost-effective, these countries can manage both treatment and fiscal sustainability. Even in countries where HIV/AIDS-related spending is high or increasing (as past infections translate into an increasing demand for treatment), the fiscal space absorbed by the costs of HIV/AIDS-related services will decline if progress in containing and rolling back the number of new infections can be sustained. The purpose of this study is to refine the analysis of the fiscal burden of HIV/AIDS on national governments and assess the fiscal risks associated with scaling-up national HIV/AIDS responses.

The study complements and contributes to the agenda on identifying and creating fiscal space for HIV/AIDS and other development expenditures. The findings from this study, and the analytical tools developed in it, could help governments in defining policy objectives, improving fiscal planning, and conducting their dialogue with donor agencies.

World Bank.Author:  Lule, Elizabeth ; Haacker, Markus.Document Date:  2011/01/01.Document Type:Publication.Report Number:65658.Volume No: 1 of 1

Benin - Second Multisectoral HIV/AIDS Control Project : restructuring

Main Report

Data Sheet

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The fiscal dimension of HIV/AIDS in Botswana, South Africa, Swaziland, and Uganda

HIV/AIDS imposes enormous economic, social, health, and human costs and will continue to do so for the foreseeable future. The challenge is particularly acute in Sub-Saharan Africa, home to two-thirds (22.5 million) of the people living with HIV/AIDS globally, and where HIV/AIDS has become the leading cause of premature death. But now, after decades of misery and frustration with the disease, there are signs of hope. HIV prevalence rates in Africa are stabilizing. This book sheds light on these concerns by analyzing the fiscal implications of HIV/AIDS in Southern Africa, the epicenter of the epidemic. It uses the toolbox of public finance to assess the sustainability of HIV/AIDS programs.

Importantly, it highlights the long-term nature of the fiscal commitments implied by HIV/AIDS programs, and explicitly discusses the link between HIV infections and the resulting commitments of fiscal resources. The analysis shows that, absent adjustments to policies, treatment is not sustainable. But it also shows that, by accompanying treatment with prevention, and making existing programs more cost-effective, these countries can manage both treatment and fiscal sustainability. Even in countries where HIV/AIDS-related spending is high or increasing (as past infections translate into an increasing demand for treatment), the fiscal space absorbed by the costs of HIV/AIDS-related services will decline if progress in containing and rolling back the number of new infections can be sustained. The purpose of this study is to refine the analysis of the fiscal burden of HIV/AIDS on national governments and assess the fiscal risks associated with scaling-up national HIV/AIDS responses.

The study complements and contributes to the agenda on identifying and creating fiscal space for HIV/AIDS and other development expenditures. The findings from this study, and the analytical tools developed in it, could help governments in defining policy objectives, improving fiscal planning, and conducting their dialogue with donor agencies.

World Bank.Author:  Lule, Elizabeth ; Haacker, Markus.Document Date:  2011/01/01.Document Type:Publication.Report Number:65658.Volume No: 1 of 1

The fiscal dimension of HIV/AIDS in Botswana, South Africa, Swaziland, and Ugandan

Countries of the Americas Advance toward Elimination of Mother-to-Child Transmission of HIV and Syphilis

Washington, D.C., Dec. 1, 2011 (PAHO/WHO) — A handful of countries in the Americas appear to have virtually eliminated mother-to-child transmission of HIV and congenital syphilis, according to a new report from the Pan American Health Organization/World Health Organization (PAHO/WHO). But the goal of hemisphere-wide elimination requires stepped-up action in countries and population groups where progress is lagging, the report says.

“The Americas is the first region in the world to set its sights on eliminating mother-to-child transmission of HIV and syphilis through simultaneous efforts in a joint framework,” said PAHO Director Dr. Mirta Roses. “This new report shows how much progress has been made but also suggests there is a lot of work that still needs to be done.”

An estimated 5,000 children become infected with HIV in the Americas each year, most through mother-to-child transmission, and between 164,000 and 344,000 babies are born with congenital syphilis. If untreated, the conditions can produce miscarriages, fetal death, premature birth, stillbirth, newborn death, low birth weight, and congenital infection with different degrees of severity. These imply major human, social and economic costs.

The countries of the Americas have collectively committed to the goal of eliminating mother-to-child transmission of HIV and syphilis as public health problems by 2015, by improving the quality of care for pregnant women and babies, including wider and timelier treatment for HIV and syphilis. The report released today assesses progress in the Region’s countries in implementing such efforts to advance toward elimination.

According to the report, Canada, Cuba, Antigua and Barbuda, the United States, and the British territory of Anguilla have all reported reduced rates of mother-to-child (“vertical”) transmission of HIV to less than 2 percent and have reduced pediatric HIV cases to no more than 0.3 per 1,000 live births, while also reducing congenital syphilis cases to no more than 0.5 per 1,000 births. These levels are considered low enough to no longer constitute public health problems, although experts say sustained efforts are needed to keep these rates low. PAHO, UNAIDS, and UNICEF have begun developing a certification process to validate countries’ progress toward elimination.

At the regional level, the report estimates the rate of mother-to-child transmission in Latin America and the Caribbean at 15 percent, significantly higher than the 2 percent rate needed to achieve elimination but lower than the 35 percent transmission rate that would occur without public health interventions. To further reduce rates, countries need to increase HIV testing in pregnant women, provide wider coverage with antiretroviral drugs for mothers and infants, and increase early diagnosis of exposed infants. Countries with the highest rates of mother-to-child transmission should rapidly scale up action in these areas, through joint efforts between health authorities, international agen­cies, academia, civil society, and other partners, says the report.

Other challenges and achievements highlighted in the report include:

• Rates of HIV screening for pregnant women are increasing in most countries and range from 21 percent in Guatemala to 97-98 percent in Canada and the United States. In Latin America, HIV screening rates are much lower for women from remote rural and indigenous areas than for urban women.
• On average, 61 percent of women receiving prenatal care in the Americas were screened for syphilis in 2010. To increase screening, the report urges wider use of rapid tests in primary health care settings.
• Coverage with antiretroviral medication increased in Latin America and the Caribbean from about 50 percent of HIV-positive pregnant women in 2005 to 61 percent in 2010.
• The percentage of pregnant women diagnosed with syphilis who receive appropriate treatment ranges from under 15 percent in El Salvador to 100 percent in Chile, Cuba, Guyana, Honduras, Trinidad and Tobago, and Venezuela (among 18 reporting countries).
• Most countries report access to prenatal care at 80 percent or better (that is, pregnant women have at least one visit with a skilled antenatal care attendant). However, early access is not necessarily the norm, and shortages of supplies and medications (HIV and syphilis tests, antiretrovirals and penicillin) often compromise the quality of care.
• Skilled attendance at birth ranges from 26 percent to 100 percent, with half of countries reporting 99 percent coverage or better. Countries with the lowest rates include Haiti (26 percent), French Guiana (49 percent), Guatemala (51 percent), Honduras (67 percent), Bolivia (65 percent), and Ecuador (71 percent).
• Indigenous women have consistently lower rates of access to prenatal care and delivery by skilled birth attendants, as indicated by data from Bolivia, Ecuador, Guatemala, Nicaragua, and Peru.
• In most countries for which data are available, less than half of youths aged 15 to 24 know how to prevent sexual transmission of HIV and also reject major misconceptions about HIV transmission.
• The percentage of unmet need for family planning/contraception ranges from a low of 6.6 percent in North America to over 20 percent in Haiti, Guatemala, Belize, Bolivia and the Caribbean overall.

The PAHO/WHO report recommends stepped-up efforts to overcome challenges in the delivery of prenatal and childbirth care and to eliminate geographic, social, economic and cultural barriers to early access to quality care.

It also recommends strengthening of surveillance and information systems related to HIV and syphilis among women and babies to eliminate data gaps, noting that many countries and territories in the hemisphere have not reported on key indicators of progress toward elimination.

Links

• 2010 Situation Analysis: Elimination of Mother-to-Child Transmission of HIV and Congenital Syphilis in the Americas
• Mother-to-Child Transmission of HIV and Syphilis Elimination Initiative: www.paho.org/eliminationinitiative
• PAHO World AIDS Day page
• PAHO HIV-STI website: www.paho.org/HIV
• “Unparalleled global progress in HIV response but sustained investment vital” (WHO news release)
• WHO fact sheet on HIV
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President Obama announces new efforts to end the AIDS epidemic in the United States

HSS. FOR IMMEDIATE RELEASE. December 1, 2011. President Barack Obama  announced accelerated efforts to increase the availability of treatment to people living with HIV/AIDS in the United States in conjunction with World AIDS Day 2011.  The president directed the U.S. Department of Health and Human Services (HHS) to invest approximately $50 million in new funding to support AIDS Drug Assistance Programs in states and increase access to HIV/AIDS care services.

“President Obama has laid out a compelling vision that has the power to change the course of the epidemic,” said HHS Secretary Kathleen Sebelius.  “Now it’s up to all of us to make our National HIV/AIDS Strategy real.  Treatment not only improves and extends the lives of people living with HIV, but it also drastically reduces their risk of spreading the virus.  Today we have a unique opportunity to significantly alter the course of the AIDS epidemic in the United States.”

The president emphasized that critical HHS resources will help ensure that HIV-positive Americans get the best care and treatment possible.  HHS will commit approximately $35 million in new funding and enhanced technical assistance through the Health Resources and Services Administration (HRSA) to support state AIDS Drug Assistance Programs so that approximately 3,000 people living with HIV/AIDS will have access to life-saving medications.  In addition, HHS will provide $15 million in new funding to support experienced community-based providers of care for individuals with HIV/AIDS.

As part of today’s announcement, HHS will sponsor new activities focused on improving adherence to medications and encouraging consistent access to HIV care.  The Centers for Disease Control and Prevention (CDC) estimates that 34 percent of HIV/AIDS patients do not receive consistent care and only 28 percent of HIV/AIDS patients have their HIV under control.  Consequently, HHS will help providers improve quality of health care delivered and states monitor and improve the continuum of HIV care for patients.

Today’s announcement builds upon the Obama Administration’s new testing initiatives to help the estimated 240,000 Americans living with HIV who are not aware that they are infected.  For example, CDC has launched a new campaign to encourage testing among one of the hardest hit populations in the United States, black men who have sex with men.  Testing Makes Us Stronger is part of Act Against AIDS, CDC’s national campaign to bring attention to the importance of HIV prevention and testing.  In 2012, CDC will also be working with partners to expand its successful campaign for African American women.

Recognizing that the federal government’s efforts are only part of the solution, President Obama also applauded commitments by other public and private sector partners to expand and improve HIV/AIDS care services.  The National Alliance of State and Territorial AIDS Directors announced a new agreement with Gilead Sciences to extend additional voluntary discounts and rebates for most Gilead medications purchased by state AIDS Drug Assistance Programs, as well as a continued price freeze through 2013.

To learn more about World AIDS Day activities, visit AIDS.gov.

Contact: HHS Press Office
(202) 690-6343s

Caribbean conference on forging a sustainable response to the regional HIV epidemic

WHO News. Monday November 21, 2011 marked the last day of the 2011 Caribbean HIV conference. Under the theme “Strengthening evidence to achieve sustainable action”, this important conference brought together more than 2700 stakeholders on November 18-21, in Nassau, The Bahamas, to focus on forging a sustainable response to the HIV epidemic in the region.

 

This event was the third Caribbean HIV conference in the past decade and was designed to build on successes of the previous events. This year’s conference highlighted two critical and related issues affecting the HIV response in the region: sustainability and the importance of evidence in guiding strategies to attain this goal.

Presentations and discussions broached issues such as the evidence of progress made in the Caribbean, the challenges in the region to sustain the response, and critical evidence-based interventions to attain HIV-free generations. (Please download the newsletter  highlighting discussions on sustainability.)

 The conference reviewed the high rates of HIV infection among certain key populations like men who have sex with men and sex workers, as well as gender relations that increase vulnerability and risk, and limited strategic information. Countries  and delegates were urged to increase domestic allocations for HIV services and programs, strengthen regional solidarity in resource allocation so that countries that are worse off will not be left behind, address inefficiencies, strengthen public health leadership and public-private partnerships, focus on evidence-based interventions, and renew emphasis on surveillance of new infections.

Through the Caribbean HIV Office (PHCO), PAHO has been actively involved in the organization of this important event. PAHO staff Dr. Noreen Jack was a member of the organizing committee and the PHCO team, and HIV advisors from the regional and country offices contributed to the agenda through presentations in plenary sessions related to sustainability of the response, poster presentations, and the coordination of four special sessions on Men’s Health and HIV,  Strengthening Sexual and Reproductive Health and HIV Linkages in the Caribbean, HIV Drug Resistance Prevention and Monitoring, and a special session on Small Island States’ Challenges to Strengthen the HIV Response, with keynote speaker the Honorable Prime Minister of St. Maarten, Sara Wescot-Williams.
 

Experts Analyze Obstacles to Universal HIV Treatment in Latin America and the Caribbean

Santo Domingo, Dominican Republic, 9 November 2011 (PAHO/WHO) — Latin America and the Caribbean have higher levels of antiretroviral treatment (ART) coverage than any other developing region, with 50 percent of people who need treatment receiving it, according to data from 2009. Nevertheless, achieving the goal of universal coverage faces serious obstacles that will require stepped-up action by governments, health systems, and international partners, experts say.

Obstacles to universal HIV treatment and how to overcome them will be the focus of a meeting in Santo Domingo this week organized by the Pan American Health Organization/World Health Organization (PAHO/WHO), UNAIDS and other UN agencies in collaboration with the Global Fund to Fight AIDS, Tuberculosis and Malaria.

“Ensuring universal access to prevention, diagnosis, care and treatment for HIV is a public health priority in our Region,” said PAHO Director Dr. Mirta Roses. “Access to treatment is not just a matter of human rights; it reduces the risk of transmission and strengthens prevention.”

An estimated 950,000 people in Latin America and the Caribbean need treatment for HIV, but only 478,000 receive it, according to a 2010 progress report by WHO, UNICEF and UNAIDS. In recent years, 40,000 people on average have begun antiretroviral treatment each year, while some 120,000 new HIV infections are reported annually. Ensuring universal access to treatment would require doubling the number of people receiving it through improvements in diagnosis and care, experts say.

People with HIV are considered in need of treatment when they have reduced levels of a type of cell known as CD4, which protects the body against infections and tumors. HIV uses CD4 cells to gain entry into the immune system and leads to a progressive reduction in the number of these cells. WHO recommends that people with HIV begin treatment when their CD4 cell count drops below 350 per cubic millimeter of blood or when they have symptoms of disease.

One of the problems facing Latin America and the Caribbean has been shortages of HIV medications. A 2011 PAHO/WHO survey of 12 countries found that two-thirds had experienced so-called “stock-outs.” This required changing or suspending treatment regimens, increasing the risk of HIV resistance and eventual treatment failure.

Experts say shortages result from several factors, including fragmented health systems, lack of integration of HIV treatment into national pharmaceutical supply systems, inefficient procurement systems, and difficulties with storage and distribution of antiretrovirals, which have increased as treatment regimens have become more complex.

Another obstacle to universal treatment is the high cost of HIV medications. In Latin America and the Caribbean, 70 percent of funds spent on HIV go to treatment, and half that amount is spent on antiretrovirals. The prices paid for antiretrovirals vary from country to country, with some paying as much as six times what others pay.

“The costs of first-line antiretrovirals have declined significantly in recent years. However, demand for other high-cost medications to cover the needs of people who have developed resistance has also increased,” said Jeffrey O’Malley, director of the HIV Unit of the United Nations Development Program (UNDP). He added, “Access to needed treatment is a matter of human rights.”

At the High-Level United Nations Meeting on HIV/AIDS in 2011, representatives of Latin American and Caribbean governments established concrete goals to provide HIV treatment for all those who need it by 2015.

“Bold goals give us the opportunity to strengthen joint efforts by governments, civil society, and cooperation agencies,” said Dr. César Núñez, regional director for Latin America of UNAIDS.

On November 9–11 in Santo Domingo, experts from PAHO/WHO, the Global Fund and UNAIDS will meet with the heads of HIV programs and managers of pharmaceutical supply systems from 16 countries, as well as with representatives of other UN agencies and civil society, to develop proposals for increasing access to HIV treatment through:

• Optimal selection of antiretroviral therapy regimens.
• Use of flexibilities in the area of patents to increase access to affordable medicines
• Simplification of treatment regimens within the framework of Treatment 2.0, a WHO-UNAIDS initiative
• Monitoring and prevention of, and rapid response to, stock-outs of antiretroviral medications.

Links:

• Antiretroviral therapy (PAHO/WHO)
• Progress Report 2010: Toward Universal Access: Scaling up Priority HIV/AIDS Interventions in the Health Sector, published by WHO, UNAIDS, and UNICEF
• PAHO Strategic Fund
• HIV treatment (UNAIDS)