10 April 2014
From Namibia to Ecuador, Senegal and Jamaica, partners in the global effort to defeat AIDS, tuberculosis and malaria are busy this month holding consultations at regional meetings about the new funding model that is now being fully implemented by the Global Fund. The meetings are inclusive, stressing the need to deepen partnerships to achieve the most effective impact. Governments, civil society, technical partners, faith-based organizations and people affected by the diseases are all taking part, to talk about how to best coordinate funding priorities with national plans and strategies for health. The new funding model relies on strong country dialogue to bring partners together to decide how best to invest, and how optimizing all available resources can serve a country’s objectives most effectively.
In Quito, Ecuador, high up in the Andes, discussions focused on the role of civil society in the new funding model and on ensuring that the most vulnerable are targeted, including men who have sex with men, transgender people and sex workers. Respect for human rights was also the focus of a workshop at a regional meeting this week with representatives from UNAIDS and the Pan Caribbean Partnership Against HIV/AIDS in Kingston, Jamaica.
At each meeting, partners voiced optimism about the great progress that has been achieved toward defeating AIDS, TB and malaria. To increase impact now, there is a need for ambitious planning and optimized use of all funding. Only by approaching health challenges holistically can countries make a transformative difference in treatment, prevention and care for those affected by the diseases.
At the regional meeting in Dakar, Senegal, more than 250 participants from 20 countries in Western and Central Africa put special focus on how issues of gender, maternal and child health and respect for human rights should be fully integrated into the new funding model, including the development of a concept note to apply for funding. The words “partnership” and “dialogue” were frequently used. “Partnerships are the key to our success,” said Tina Draser, the Global Fund's Regional Manager for Western Africa. “If we work together and listen to each other, the new funding model could transform the lives of millions of people affected by the three diseases.”
Countries in the Western and Central Africa region will receive US$4.58 billion in the funding period, an increase of 64 percent compared with the previous period.
“The new funding model brings with it the challenge of collaborating with all stakeholders and including them in the fight against the three diseases,” said Louis Pizarro, Director-General of Solthis Therapeutic Solidarity and Initiatives Against HIV/AIDS. “Therefore, it is important that the technical partners make themselves available to work with the recipient countries to support them in this process.”
Participants in the meeting voiced recognition that people the most affected by the disease be involved at each stage of the process, including the drafting of a concept note. Those are the people who are also often the most socially marginalized — women and girls, sex workers, people who inject drugs, men who have sex with men, migrants and prisoners. “In order to take up the challenge of full inclusion of vulnerable groups, we must organize a number of meetings for the purpose of sharing and exchanging with key groups, and work together to set priorities,” said Magatte Mboj, Executive Director of the National Alliance against AIDS.
The meeting closeed with words from Leopold Sédar Senghor, the Senegalese poet, quoted by Ronald Tran-Ba-Huy, a Regional Manager for Central Africa at the Global Fund. “The poem is only complete when it becomes song, speech and music at the same time,” he said. “It is like a jazz score, where the execution is as important as the text.”
The Global Fund is moving forward with sourcing and procurement agreements that will save significant amounts of money and lead to an even greater impact in fighting HIV, tuberculosis and malaria. With a more proactive approach, the Global Fund is seeking new frameworks that can improve transparency, fair prices, and better capacity planning and delivery. Cooperation is expanding in several areas. One is viral load HIV testing. The Global Fund and partners are working with manufacturers on an approach that will allow a significant expansion of testing, with lower prices. It’s the result of a partnership between the Global Fund, the U.S. President’s Emergency Response to AIDS Relief (PEPFAR), USAID, the U.S. Center for Disease Control and Prevention, and the Government of South Africa. Other partners include the Clinton Health Access Initiative (CHAI), UNICEF, UNITAID, WHO, Medecins Sans Frontieres and the African Society of Laboratory Medicine. Partners are working with manufacturers on an approach that will support a significant expansion of testing. That way, they achieve greater value through lower pricing and better contracting to support greater utilization of the testing platforms.
HIV-1 viral load refers to the number of viral particles found in each milliliter of blood. The more HIV-1 viral particles in the blood, the faster the CD4 cells are likely destroyed and the faster the progress toward AIDS. It can also prevent people from being unnecessarily switched to more expensive ‘second-line’ medicines. Globally, more than 6 million people living with HIV have access to antiretroviral therapy under programs supported by the Global Fund. Maintaining the long-term effectiveness and quality of ART is essential to sustaining and expanding the global HIV response.
Honduras, a small republic in Central America, has been able to demonstrate good sustainability and country ownership in the years it has been implementing programs responding to HIV. Honduras has now absorbed almost 100 percent of the purchase of anti-retrovirals for people living with HIV, and the Ministry of Health has a specific budget allocation for such purchases. This is a complete change from 10 years ago. In 2003, Global Fund programs provided all ARV treatment in the country. In another indicator of progress, 88 percent of the country’s medical staff providing care for patients with HIV and AIDS is now funded entirely by the Ministry of Health. Determination, commitment and vision by the government, with training and updating human resources in alignment with the country’s new National Health Model, are evidently paying off. There are 9,569 patients on ARV treatment in Honduras, a country with a population of 8.2 million people.
The success in Honduras is winning notice from neighbors and peers. A recent report by the Pan American Health Organization, the regional office of the World Health Organization, singled out Honduras for already adopting the WHO recommendation to initiate treatment in adults living with HIV when their CD4 cell count falls to 500 cells or less. How does a country in which more than two thirds of its population lives in poverty and with significant development challenges accomplish such a feat in just 10 years? “Through strenuous work, going step by step and always keeping faith that we could do it,” Edna Yolani Batres Cruz, the Minister of Health for Honduras, told a regional meeting of partners from Latin American countries in Quito last week.
Cesar Núñez, regional director for UNAIDS in Latin America, said Honduras could be a model of sustainability for bigger countries in the region.
Batres Cruz said the next challenge for Honduras was strengthening HIV prevention services for vulnerable populations, including transgender population, men who have sex with men and female sex workers, where prevalence rates are significantly higher. Improving diagnostic services and ensuring the continuous supply of medicines and health provisions at the health facilities are other goals for the future. “We are a small country with a small economy, but we showed we can stand on our own feet.”
John Rae is a documentary and commercial photographer who has worked with the Global Fund since 2002 and delivered many memorable images. Over the years, John has visited over 45 countries to document efforts to defeat AIDS, TB and malaria. Here is another one of his favorites, and the story behind it:
Several years ago, I went to Hyderabad, India, to accompany HIV outreach workers on their rounds. As the sun went down and the smell of the cooking fires came up, we got to our last visit of the day. Driti, an outreach worker, led us down a dirt alley between two broken down houses. She explained that we were going to a safe house for women with HIV. We stopped before a large black metal door with a small peep hole in the middle. Driti knocked. When it opened, we entered a dirt courtyard with a small house in the back, all surrounded by tall walls. We met a woman named Akshaya and her two children, ages 3 and 5. She welcomed us, and we sat down on a rickety bench. She told us her story.
When she was 16, she was forced into an arranged marriage with a man who was 57. As tradition dictates, she went to live with her husband’s family. She had to answer to her new mother-in-law. Her husband was a truck driver and often left for weeks at a time. Akshaya was not allowed to leave the house except for errands. After the birth of her second child, Akshaya began to feel tired and sick. The hospital tested her for HIV. She was positive. Akshaya was confused. She had been faithful to her husband. Yet when he heard the news, he got angry, accusing her of bringing shame upon his household. He beat her. Others in the household felt obligated to believe the husband’s story, that it was her fault. When he tested positive for HIV he blamed his infection on Akshaya.
One night, Akshaya woke up just as her husband threw a bucket of kerosene on her and lighted the match. Miraculously, Akshaya survived the attack, later called a “kitchen accident.” She was able to enter a program that helps women in her situation, supported by the Global Fund. She now gets ARV medications and is in training to be an HIV outreach worker herself, able to use her own experience to try to protect other women. She said she planned to relocate with her children, once her training was complete.
Listening to Akshaya’s story was draining. But it was also inspiring that she now is working to support others. As we left, I asked Driti: “What happened to her husband?” Driti said he came to the safe house at night sometimes, often drunk, and beat on the door. He was not let in.
For more of John Rae’s work: www.raephoto.com.