Brazil's Aids policy 'remarkable'

By, Gary Duffy, BBC News, November 14, 2007

Bargaining with pharmaceutical firms to bring down the price of Aids drugs and producing cheap generic versions has saved Brazil $1bn, a study has shown.
Infection rates in the Latin American country have been kept at a similar level to the US, the report finds.

And more than 180,000 Brazilians have access to Aids treatment.

Brazil's achievement is described as "remarkable", in the study published by researchers at the Harvard School of Public Health in the United States.

Brazil's policy for dealing with HIV and Aids has long been widely admired for its commitment to effective treatment combined with an aggressive promotion of the safe sex message.

In 1996 it became the first developing country to commit to providing free and universal access to Aids drugs.

Broken patent

Now a study published in the Public Library of Science journal by researchers from the Harvard School of Public Health suggests the policy has saved Brazil around $1bn between 2001 and 2005.

By threatening to produce cheaper generic versions of existing drugs, the government has repeatedly persuaded companies to reduce their prices.

Earlier this year Brazil broke the patent on the Aids drug Efavirenz and decided to import a cheaper version from India.

Drugs companies have warned that action like this would only discourage them from carrying out the expensive research needed to improve the drugs required to treat HIV.

Brazil says the decision was taken in the public interest, which is why it also produces generic versions of eight drugs that do not have patents.

To some extent the policy has been a victim of its own success, with the new research suggesting drug costs rose rapidly as treatment was provided to more people who were also living longer.

Researchers also say other developing countries are now proving more successful in producing cheaper generic Aids drugs and Brazil, which once led the way with this approach, needs to be more aggressive.


Source: http://news.bbc.co.uk/2/hi/americas/7093809.stm

Good news for persons with HIV/AIDS: Global Fund to continue providing antiretroviral medication

By, The Jamaica Observer, October 27, 2007

The Global Fund has committed to continue providing antiretroviral medication for another six years for Persons living with HIV/AIDS (PLHIV), according to the Ministry of Health.

A number of PLHIVs in Jamaica and other developing countries had expressed concerns about their ability to access the drug at the end of Global Fund's five-year funding, which see them receiving the medication at a minimal cost or free of cost.

Prior to Jamaica receiving US$23 million from the Global Fund in 2003, persons with HIV/AIDS had to pay up to $30,000 for a month's supply of the drug. Today these persons are only required to pay $1,000 for the drug, but can receive it free of cost if they are unable to pay.

"The Global Fund, in committing to be around to support PLHIV, has developed a new approach for funding whereby if you perform well and maintain an 'A' rating throughout the grant you will automatically be offered a six-year extension and we have," said Dr Kevin Harvey, co-ordinator of treatment care and support at the Ministry of Health.

However, Dr Harvey said they have made allocation in the next proposal, for the drug to be provided free of cost to all.
Harvey was addressing PLHIVs and major stakeholders at the Jamaica AIDS Support for Life (JASL) and the Latin America and the Caribbean Council of AIDS Service Organisation (LACASSO) breakfast meeting at Eden Garden Restaurant in Kingston.

Dr Harvey said the ministry was, in the meantime, awaiting the approval of its latest proposal to Global Fund where some US$44 million was requested to continue the fight against the deadly disease.

Of the 175 proposals received worldwide for Global Fund support, 72 have been recommended for funding. However, Jamaica will have to wait until November when the board and the technical review panel meet to know if they are approved.
"I would be very disappointed and surprised if we were not one of the persons selected," said Dr Harvey.

Under the last proposal which lasted five years, Jamaica was awarded US$23 million which assisted in providing medication for 3,500 of the 5,000 persons who needed it.
Today, he said, it is estimated that between 7,000 to 8,000 persons need to be put on ARV medication.

"The task, however, is to provide universal access to treatment care and support and that is why we need to get the proposal for US$44 million approved so we can scale up and try and provide medication to at least 80-90 per cent of who need to be on it," he said.

Dr Harvey said, too, that providing persons with ARV was very critical as it was assisting PLHIVs to live longer, more meaningful lives .
"We have seen in children over a 40 per cent decrease in death rates from AIDS and a 36 per cent reduction in adults," he said.

Source: http://www.jamaicaobserver.com/news/html/20071026T210000-0500_128737_OBS_GOOD_NEWS_FOR_PERSONS_WITH_HIV_AIDS_.asp

Central America suffers highest HIV, AIDS rates in Latin America

By, www.chinaview.cn, November 5, 2007

Central America is suffering the highest HIV and AIDS rates in Latin America, the Joint United Nations Program on HIV/AIDS (UNAIDS) said Monday in a statement.

In Central America, there are 1.7 million people with HIV, of whom 208,600 have AIDS, UNAIDS said. The figure includes Belize and Panama, which are frequently excluded from the region's statistical base.

"In 2010 the Central American epidemic could reach an infection rate of two percent in the adult population," the organization said.

UNAIDS is taking part in the fifth Central American People With HIV/AIDS Encounter, which began in the Nicaraguan capital Managua on Sunday. The conference's motto is "Our response: seeking equality, diversity and fighting discrimination faced with HIV and AIDS."

The meeting, aimed to help people with HIV or AIDS to exchange their experiences, will focus on women and children with HIV/AIDS in the region.

Nicaragua is also hosting the fifth Central American Congress on HIV, which is a part of the meeting.

The congress is a policy-oriented event designed to influence the region's politicians and achieve universal access to prevention, support and treatment of HIV/AIDS.

Source: http://news.xinhuanet.com/english/2007-11/06/content_7018380.htm

Missing the target: Failing to provide universal access

By, Masimba Biriwasha, Zimbabwe, HDN Key Correspondent Team, August 2, 2007

The goal of universal access to HIV treatment by 2010 is in danger of being missed, according to a report issued by the International Treatment Preparedness Coalition (ITPC), a coalition of HIV activists from more than 125 countries.

The report, titled 'Missing the target', said that plans to rapidly expand access to treatment to 10 million people by 2010 would not be successful unless efforts were drastically increased.

Despite evidence to show that HIV treatments prolong life, many people around the world continue to die of the disease. In 2006 alone, three million people succumbed to AIDS. Many of these lives could have been saved by greater access to treatment and health-care services.

Although some progress has been made towards improving access to treatment, many people continue to be denied access to essential, life-saving drugs. In developing countries, just 28% of the 7.1 million people who need HIV treatment are receiving it.

According to ITPC, which has conducted an analysis of HIV treatment in 17 countries, only 700,000 more people received treatment in 2006 than in the previous year. The group said that if the rates of treatment expansion were not tripled, the goal of universal access by 2010 would not be realised.

"The slow progress has already cost thousands of lives, and is destined to cost millions more. This is particularly tragic because evidence shows that AIDS treatment delivery is working," the ITPC report said.

Poverty remains a key factor impeding access to antiretroviral drugs (ARVs). Many people who do have access to the treatment do not have the money to feed themselves or access other vital health care services.

What is often called 'free treatment' remains out of reach for the vast majority of people in need, with transport and diagnostic testing costs often proving prohibitive, the report said.

"While timely and expanded distribution of ARVs remains the core objective, much greater attention is now needed on emerging challenges such as reaching marginalized groups, children, and people in rural areas, and providing vital support services such as transportation and nutritional assistance," ITPC's report said.

The collapse of health systems in many of the countries with high HIV prevalence rates is also a significant contributing factor to the failure to reach many people affected. Even where the drugs are available, if there are no health care workers to administer them, access to treatment will not improve.

The worsening shortage of doctors, nurses, and community health workers who can provide HIV care needs to be tackled with increased financial investments and policy reforms, according to ITPC.

"Developing country governments must take on greater leadership on HIV/AIDS. People living with HIV and civil society must engage with their governments and insist they do more. In advocating for change, [people living with HIV] and civil society often face serious challenges and risk," said the report.

It also accused donors of failing to establish a successful formula for securing the regular and reliable funding essential to universal access efforts. ITPC said that funding agencies needed to make more visible efforts towards increasing access to treatment among poorer communities and integrating tuberculosis (TB) and other treatments into health services.

"UNAIDS and WHO provide important assistance on global treatment scale up through policy development and, in some cases, through efforts that facilitate the inclusion of civil society," the report said.

"But these agencies must be more outspoken when national programmes are mismanaged, targets are not met, or vulnerable populations are neglected; it is part of UN's moral responsibility to speak out when countries fail their people."


HDN 2007

Source: http://www.thecorrespondent.org/featuredarticle.view.aspx?a=1caae13b-8b09-49b4-8685-3417dcc1e61a

AIDS: Winning the Fight, Losing the War

By, Chinua Akukwe, Worldpress.org, October 22, 2007

The fight against H.I.V./AIDS is throwing up an unlikely scenario whereby steady progress made in the fight against the epidemic may not translate into significant gains in the long-term war against the global epidemic. How is it possible to be on a winning streak in the fight against H.I.V./AIDS in the short term and yet be in danger of losing the long-term battle to contain the epidemic?

It is important to begin with a summary of the known impact of H.I.V./AIDS in the last 25 years. According to the United Nations agency coordinating response to the epidemic, UNAIDS, 65 million individuals have contracted H.I.V. since 1981. At least 39.5 million people live with H.I.V. In the last 25 years, 25 million people have died of AIDS. In 2006 alone, 4.3 million individuals contracted H.I.V. and 2.9 million died of AIDS. Countries with a huge AIDS burden face contracting economies and work force shortages.

Winning the Fight and Losing the War Against H.I.V./AIDS
I briefly discuss how we are winning the fight and yet are in danger of losing the long-term battle against H.I.V./AIDS.

The international resolve to fight AIDS reached unprecedented momentum in 2001 when the United Nations General Assembly, in a special session, adopted the Declaration of Commitment on H.I.V./AIDS and Millennium Development Goals, explicitly recognizing the need for a strong political will in the fight against the epidemic. The declaration also highlighted the need for coordinated resource mobilization in fighting and reversing the impact of the epidemic by 2015. The General Assembly reaffirmed its commitment to the fight against AIDS with the 2006 Political Declaration on H.I.V./AIDS, urging universal access to H.I.V. prevention, treatment, care, and support by 2010. The 2006 declaration emphasized the role of stable and adequate long-term financing strategies. The creation of the Global Fund to fight AIDS, Tuberculosis, and Malaria to finance remedial efforts is a testament to the global resolve on AIDS. The United States government program against AIDS (PEPFAR) committed $15 billion over five years, making it the largest bilateral program of its kind. The European Union and the Gates Foundation also significantly increased their support of global AIDS efforts. The United Nations reports that at the end of 2006, 90 countries had set national H.I.V./AIDS remedial targets and 25 countries had developed costed, priority national plans.

An unequivocal evidence of the steady progress in the fight against H.I.V./AIDS is the level of financial support available worldwide. The UNAIDS indicates that funding for global H.I.V./AIDS rose from $300 million in 1996 to $8.9 billion in 2006. Funding for H.I.V./AIDS programs worldwide is expected to reach $10 billion in 2007.

However, in long-term war plans, the dramatic increase in financial support is less than half of what is needed to fight the epidemic. At least $18 billion is needed in 2007 and another $22 billion in 2008. The UNAIDS estimates that to achieve universal access to H.I.V./AIDS services by 2010, $32 billion to $51 billion will be needed. Today, there is no credible evidence that needed financial resources will be available by 2010.

Steady progress is also evident in access to lifesaving antiretroviral therapy. In 2004, about 300,000 individuals were on antiretroviral therapy worldwide. By the end of 2006, 2.2 million individuals were receiving antiretroviral medication. The increased access to treatment is remarkable. However, the impressive numbers of individuals on treatment belie five ominous concerns, with grave implications in the long-term battle against AIDS.

First, individuals currently receiving treatment represent less than 30 percent of the 7.1 million people clinically qualified to receive antiretroviral medications. These individuals will likely die without treatment. Second, the scale-up of antiretroviral therapy is not keeping pace with clinical need, leading to an increase in the number of AIDS deaths. In 2006, 2.9 million people died of AIDS compared to 2.2 million in 2006. Third, for every one person on antiretroviral therapy, six new people contract H.I.V., signaling a losing battle in the long term. Fourth, only 10 percent of pregnant women with AIDS receive treatment to prevent H.I.V. transmission to their newborns. Every year up to 500,000 pregnant mothers transmit H.I.V. to their newborns. Fifth, a recent study indicates that more than one-third of individuals on antiretroviral therapy in Africa die or discontinue treatment within two years. These individuals die or discontinue treatment for a number of reasons, including commencing treatment very late in their illness, and dying shortly thereafter; inability to travel long distances to receive medications in health facilities; inability to pay for treatment; and the difficulties of juxtaposing struggle for daily survival with the logistics of keeping up with treatment schedules and protocols.

The prevention of new H.I.V. infections has received considerable planning and implementation attention in the fight against the epidemic. Innovative information, education, and communication campaigns have been introduced, focusing on the needs and priorities of target populations. Scientists are working in an unprecedented collaborative effort to produce H.I.V. vaccines. A very promising weapon in the battle to prevent new H.I.V. infection is the preliminary result that male circumcision can reduce new heterosexual infections by up to 60 percent. A recent study in South Africa suggests that exclusive breastfeeding for the first six months of life can reduce the risk of pregnant women transmitting H.I.V. to their babies.

However, the battle to prevent new H.I.V. transmission faces long odds. A credible, clinically effective, and deployable H.I.V. vaccine is 7 years to 10 years away, removing the scenario of a potential quick fix. As earlier noted, six new infections occur for every one person on antiretroviral therapy. More than 90 percent of individuals living with H.I.V. are unaware of their status and may unwittingly continue to transmit the virus. The UNAIDS estimates that only 15 percent of individuals at risk of H.I.V. transmission in some countries are benefiting from appropriate preventive strategies. H.I.V. prevention programs also suffer from inadequate funding. In addition, preventive programs are spread thinly among at-risk groups, with insufficient program attention directed toward behavior modification among target populations.

Although H.I.V./AIDS has multisectoral consequences, most current programs lack linkages to other health and social risk factors that can facilitate H.I.V. transmission. Today, H.I.V./AIDS programs are not adequately addressing the needs of AIDS orphans and street children. Ongoing AIDS programs are rarely integrated with initiatives that prevent childhood and maternal deaths. In most AIDS hard hit countries, programs are not tightly coordinated with national initiatives on poverty alleviation, education, gender equality, and human rights. Fragmented and dysfunctional health systems in countries with a heavy AIDS burden remain long-term concerns. Lack of a qualified health workforce is another long-term threat.

Perhaps, the most fundamental threat in the long-term battle against H.I.V./AIDS is the current lackluster community-based response to the global epidemic. As the emergency response phase of the global epidemic slowly gives way to the phase of leveraging resources, mobilizing target populations, and sustaining successful programs, the long-term battle against the epidemic will be fought at community levels where individuals infected and affected by H.I.V./AIDS live and die. A strong community-based response to H.I.V./AIDS should include sustained information, education, and communication campaigns directed at specific target populations or cohorts; timely access to quality clinical care and support programs; and the availability of comprehensive social services.

Conclusion
The H.I.V./AIDS epidemic continues to challenge the collective will of the international community. The last six years has witnessed unprecedented short-term wins in the fight against the epidemic. Financial, technical, and logistics resources have increased significantly. However, we are in the danger of losing the long-term battle to prevent new H.I.V. infection, to provide timely antiretroviral therapy and support care, and to deal with health and nonhealth facilitative factors that help sustain the epidemic. We are also yet to begin the long battle against H.I.V./AIDS in the communities where the global epidemic is wrecking its most havoc.


Source: http://www.worldpress.org/Americas/2970.cfm

Country Doing Well in Universal Access

By, Trading Markets.com, October 9, 2007

Panos Southern African HIV/AIDS regional programme manager, Lilian Chigona, recently came to Botswana to brief the media about Universal Access.

Chigona briefed the media about Universal Access, which "is the right and ability to receive comprehensive, uniform and an affordable set of confidential and appropriate health services. The three aspects of the programme are prevention, treatment, care and support."

Present at the workshop were representatives of different organisations amongst them, National AIDS Coordinating Agency (NACA), the National ARV Therapy Programme, called MASA and Botswana Network on Ethics, Law and HIV/AIDS BONELA, who were afforded the opportunity to brief the media on the progress of Botswana on the Universal Access issue.

The meeting heard that the Botswana tended to concentrate on treatment while prevention and the care and support aspects were overlooked.

To emphasize the importance of other aspects when comes to dealing with HIV/AIDS, Chigona gave an example of Angola and Zambia.

She said that Angola had the lowest prevalence HIV rate.

"With the low prevalence in Angola the country could invest less on treatment and focus more on prevention to combat incident rates. On the other hand, Zambia needed to invest more on both treatment and prevention to combat both the high incidence and prevalence rates.

Botswana' prevention efforts seem to be lagging behind, but with the on-going research on the Truvada Pill (a combination of two ARV drugs that researchers think might prevent HIV) the country is coming to the party.

Chigona went on to point out that although the treatment issue was being addressed there are still people not adhering to the medication because of religious beliefs while others think that they have been cured once the ARV starts working on them.

"There are some people who tend to think that they have been cured once the HIV related symptoms disappear after they have taken the drugs for some time, while others are told by their pastors that they have been cured when that is not the truth."

These people usually return to hospitals when too ill and are put on the second line of treatment.

"But once you start resisting the second it's over for you. In Zambia, there are only two lines of treatment," said Chigona.

The meeting heard that Botswana is one of the few lucky African countries which provide the third line of treatment, as most countries only give the first and second line of treatment. But once one is resistant to the third line of treatment, "it's over".

Chigona appealed to the media to avoid "AIDS Fatigue" as the battle is still far from over. She also asked the journalists to always make sure to communicate the correct health information.

Joshua Machao, ARV' Coordinator at Masa Antiretroviral Therapy, said that in June 2006 at the Botswana United General Assembly High Level Meeting on HIV/AIDS, they had agreed to work towards the goal of "Universal Access to comprehensive prevention programmes, treatment, care and support by 2010."

In terms of accessing treatment Botswana accounts for Over 90, 478 people on ART.

"By July 2007 Botswana was providing 6,882, about 9% of children with HIV treatment. In a survey that was conducted in 2004 it was also discovered that stigmatization attitudes are lowering in Botswana and this was due to the fact that treatment access helps to reduce HIV stigma."

Oratile Moseki of BONELA revealed that people most at risk of contacting HIV are Sex Workers, men having sex with other men, children born from HIV positive mothers, prisoners, partners of persons living with HIV and gay men.

Despite being hailed a success story in other areas, Moseki observed that Botswana was behind in her response to the most 'at-risk' groups and it has been proven by the National Spending Assessment commissioned by NACA that there is zero spending on these groups.

"The national response to date is the prevention of mother to child programme (PMTCT), routine HIV testing, TB monitoring & control, home based care programmes, ARV Programmes and the multi-sectoral approach policed by National AIDS Council & facilitated by National AIDS Coordinating Agency (NACA)," she said.

Panos works with the media and other communicators to foster debate on under-reported, misrepresented or misunderstood development issues.

Their headquarters are in London with branches in Paris, the Caribbean, South Asia, East Africa, West Africa, Southern Africa and Canada; Panos Southern Africa is based in Lusaka, Zambia with HIV/AIDS issues at the forefront of all agendas in all the Panos branches.

Source: http://www.tradingmarkets.com/.site/news/Stock%20News/683578/

Zimbabwe’s HIV infection rate continues to fall

By, Webwire, November 2, 2007

New data shows that Zimbabwe’s HIV rate continues to drop, giving it one of the most significant and rapid declines of any country in the world.

The overall HIV prevalence among antenatal clinic attendees (pregnant women) decreased from 25.7per cent in 2002 to 21.3per cent (2004) and now to 17.7per cent in 2006. Based on this, Zimbabwe’s Ministry of Health and Child Welfare and international experts today published the new estimate of the HIV sero-prevalence rate among Zimbabwe’s adult population to be 15.6per cent.

The new data reinforces Zimbabwe’s successes in behaviour change among young people. The biggest falls among pregnant women were recorded among the 15-24 year age group, showing a drop in HIV from 20.8 percent to 13.1 percent in just four years (2002 to 2006).

“Young people are having fewer partners and using more condoms,” said UNFPA’s Representative in Zimbabwe, Bruce Campbell. “They have heard the messages, taken action, and are being safer. Now we must continue our combined efforts to ensure national HIV prevention programmes have an even greater reach.”

Zimbabwe was one of the first countries to develop a comprehensive epidemiological review which resulted in an evidence-based behaviour change strategy. Promotion of partner reduction and consistent condom use remain at the core of the strategy.

Under the leadership of the National AIDS Council, and with critical financial donor support, UNICEF and UNFPA have enlarged their behaviour change programmes for young people both within and out of the school context. With additional funding they will continue to broaden these programmes, in particular around girl empowerment, teacher training, youth education through sports, and training more peer educators.

The United Nations in Zimbabwe said that today’s announcement underscores the need to strive for continued broad behaviour change promotion and universal access to quality HIV prevention, as well as adolescent sexual and reproductive health services. Without ongoing and substantial support, the current positive national trends will not be sustainable.

Strong government commitment that has led to early investment in education and health sectors, the establishment of an AIDS Trust Fund, and the early creation of a National AIDS Control Programme (now the National AIDS Council), have all been immensely influential in the drop.

“It is imperative that all partners adhere closely to the concept of ‘three Ones’,” said Country Director of UNAIDS, Dr Kwame Ampomah. “One of our greatest achievements over the last few years has been a truly collaborative and concerted effort to ensure that all partners support the National AIDS Strategic Plan (ZNASP), and that there is only one national coordination mechanism led by the National AIDS Council, and only one comprehensive and integrated Monitoring and Evaluation System.”


Said UNICEF’s Representative in Zimbabwe, Dr Festo Kavishe: “Zimbabweans have again shown that they have the determination and the education to defeat HIV/AIDS, and a variety of causes of child mortality. However, mortality also played a hand in the drop and there remains an urgent need to boost prevention and treatment programmes in Zimbabwe.”


Currently around two-thirds of people who need treatment are not receiving it, and so without a significant additional injection of funds, universal access will not be attained. Moreover, while there has been an increase in geographical expansion of prevention of mother to child transmission (PMTCT) services in Zimbabwe, much more needs to be done for successful scaling-up of programmes. There are an estimated 98,000 HIV positive pregnant women in need of PMTCT services, far more that the 8500 who received them in 2006.

“There is no doubt that a drop in the rate is great news,” said WHO Representative in Zimbabwe, Dr Mandlhate. “However let us recognize that a sero-prevalence rate of 15.6per cent remains high and this is not the moment for relaxing. Rather we must take advantage of this positive action by youth and put even greater energy and resources. The United Nations family reiterates its commitment to supporting Government efforts towards the achievement of universal access of HIV prevention, treatment care and protection for those living with HIV and their families.”

Source: http://www.webwire.com/ViewPressRel.asp?aId=51842

U.N., Google, Cisco Systems Launch Web Site Aimed at Providing Data on Millennium Development Goals

By, Kaisernetwork, November 5, 2007

The United Nations, Google and Cisco Systems on Thursday launched a Web site aimed at providing data and information on global efforts to meet the U.N. Millennium Development Goals, the AP/International Herald Tribune reports.

The Web site, called MDG Monitor, will provide updated information on efforts to fight malnutrition, poverty and diseases, such as HIV/AIDS, tuberculosis and malaria. In addition, site users can use Google Earth's map and satellite images to explore places where programs aimed at meeting the MDGs have been implemented, Michael Jones, chief technologist for Google Earth and Maps, said. U.N. Secretary-General Ban Ki-moon added that the site will provide information for policymakers and development experts to learn from successes and setbacks in other countries and will increase public awareness about efforts to achieve the goals.

Ban said the new Web site is "crucial" because it will provide information about the MDGs in one place "for all who seek it with a few simple clicks of the mouse." He added that "achieving the MDGs is a matter of political will" and that the "resources, knowledge and tools for achieving the goals do exist."

The project -- which received $150,000 from corporate donors -- has a total budget of $200,000, according to the U.N. Development Program, which is facilitating the site. Data on the site are compiled from U.N. agencies, the World Bank and governments, Kemal Dervis, UNDP administrator, said. Dervis added that data can be hard to obtain and can differ among sources. The United Nations "hope[s] to gradually ... open the site to all organizations who gather statistics to offer their information," Dervis said (AP/International Herald Tribune, 11/2).