PEPFAR may soon begin distributing microbicide gels

Earlier this year, a clinical trial found great promise for the use of microbicide gels to prevent the spread of AIDS. In an interview with Reuters Alert Net, the head of the US President's Emergency Plan for AIDS Relief program says they would like to start distributing the gels once regulatory hurdles are cleared.

Writer Andrew Quinn interviews PEPFAR head Eric Goosby talks about the future methods of the program.

"We would support PReP in terms of high risk populations," Goosby, the U.S. Global AIDS coordinator, told Reuters, adding that various country approval plans were already under internal consideration.

Goosby said microbicide gels -- a focus of hope since a South African clinical trial this year showed at least one version lowered HIV infection rates -- could also play a part once full regulatory approval is obtained and more is understood about how they work.

"We haven't worked out the delivery system or the dosing or interval of application," Goosby said. "We are absolutely positioned to engage in it as soon as we know those."

Goosby spoke as PEPFAR signed a new five-year deal with South Africa to bolster its AIDS fight, signaling a deepening cooperation between Washington and a country once depicted as representing the wrong approach to the AIDS epidemic.
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The addition of PrEP and microbicide gels could represent a potentially large new budget item for PEPFAR, the $18.8 billion program launched by former President George W. Bush, but Goosby said new efficiencies in both care and treatment were already streamlining the overall bill.

He said South Africa had proposed using PrEP to treat uninfected inmates in South Africa's prisons -- a major vector for HIV -- while pilot projects elsewhere were looking at sex workers and men who have sex with men.

WHO cites improvement in battling AIDS

A new study from the World Health Organization points out the great strides made in recent years in combating HIV/AIDS. Increased funding to the US PEPFAR program, and the Global Fund have helped to improve testing, survival, and transmission. In the last couple of years, contributions to those two programs have either flat-lined or decreased. This study gives more evidence to how important continued donations of aid can be in helping people live through AIDS.

From the IPS, writer Susan Anyangu-Amu focuses on how mother to child transmissions of AIDS have improved in recent years.

According to a new report Towards Universal Access, the proportion of pregnant women in Sub-Saharan Africa who received an HIV test increased from 43 percent in 2008 to 51 percent in 2009. The report by the World Health Organisation (WHO), the United Nations Children’s Fund (UNICEF) and the Joint United Nations Programme on HIV/AIDS assessed HIV/AIDS progress in 144 low- and middle-income countries.

It found an estimated 24 percent of the approximately 125 million pregnant women in these countries received an HIV test in 2009, an increase from 21 percent in 2008 and eight percent in 2005. Fifty-four percent of HIV-positive pregnant women in Sub-Saharan Africa received antiretroviral drugs to prevent transmission to their children in 2009, up from 45 percent in 2008.

Speaking to IPS during the launch of the report in Nairobi on Sep.28, UNICEF regional director Elhadj As Sy said the progress made in the prevention of mother-to-child transmission is testimony of the fact that virtual elimination by 2015 is achievable.

"What we need is strong political leadership, funding, good programs and activism. If we build on the progress and with renewed commitment we are well on our way to achieving virtual elimination by 2015," Sy said. However, despite the progress there are still challenges with disparities between regions and within countries.

Four countries in the region report providing HIV testing and counselling to over 80 percent of pregnant women. They are South Africa, Zambia, Namibia and Botswana. These countries have already reached the target set at the United Nations General Assembly Special Session (UNGASS). This is the target of providing 80 percent of pregnant women in need of treatment with antiretroviral drugs to reduce transmission to their children.

Despite the marked progress, countries in Eastern and Southern Africa fared better than their counterparts in West and Central Africa. In Eastern and Southern Africa, 50 percent of pregnant women received HIV testing and counselling, an increase from 43 percent in 2008. In Western and Central Africa, coverage increased from 16 percent to 21 percent between 2008 and 2009.

"While the figures in Western and Central Africa are low, this does not mirror failure on their part. The burden of HIV/AIDS has leaned heavily on Eastern and Southern Africa and this is where most interventions have been directed. Western and Central Africa are just beginning to pick up the problem and their burden of the epidemic is lower," said Dr. David Okello. Okello is director, HIV/AIDS, Tuberculosis and Malaria Cluster at the WHO regional office for Africa.

Thousands refused ARV drugs in Uganda

Due to funding shortages many people in Uganda who need anti-retro-viral drugs for HIV-AIDS treatment are unable to get them. An informal ban on new patients receiving the drugs has been instituted in Uganda.

The two biggest donors of Uganda's ARV treatment program blame the global recession for the funding gaps. The Global Fund on AIDS, Malaria and TB has cut back on funding the program, while the US President's Emergency Plan for AIDS Relief has kept funding levels the same. The leveling of funds to PEPFAR come despite campaign promises from now President Obama to put more money into the program.

From All Africa, writer Henry Zakumumpa tells us why the people are not getting live saving drugs.

Several organisations caring for people living with HIV/AIDS in Uganda have sounded alarm bells regarding their members who are being turned away at anti-retroviral treatment centres even when their CD4 counts (which determine patient immunity levels) show that they are due for treatment. An evening television news report on NTV Uganda on June 16 June, 2010 highlights the plight of hundreds of people with HIV/AIDS who are stranded at treatment centres which have declined to enroll them on treatment citing severe funding dilemmas for the lifelong ART drugs.

For people with HIV/AIDS, anti-retroviral treatment is the main hope of prolonging life. Anti retroviral drugs (ARVs) inhibit the ability of the HIV to multiply in the body.

Dr Peter Mugyenyi, the Executive Director of the Joint Clinical Research Centre (JCRC), one of the leading national providers of HIV/AIDS care and treatment in Uganda, acknowledges the problem.

"In Uganda, lower- than- anticipated funding support from PEPFAR and other donor entities in the past couple of years has forced many facilities to turn away new HIV-positive patients seeking ART," Dr Mugyenyi says in a foreword he wrote for the latest 2010 report of the International Treatment Preparedness Coalition (ITPC) entitled Rationing Funds, Risking Lives: World Backtracks on HIV Treatment.

Dr Deus Lukoye, the Kampala City Council HIV/AIDS Focal Person, has confirmed to this reporter that many ART sites in Kampala are turning away new patients due to donor funding deficits.

According to Prof. Michel Kazatchkine, Head of the Global Fund on AIDS, Malaria and TB, the United States President's Emergency Plan for AIDS Relief (PEPFAR) programme and the Global Fund together are providing almost 100% of the funding for ARV treatment costs in developing countries such as Uganda.
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"I can't believe the world will let me die when the money that is needed to put me on treatment and prolong my life, for my family's sake at least, is available globally and even in my own country" says James Mbidde (not real name), 38, who has been turned away at two ART centres in Kampala.

US pledges $2.7 billion dollars for Kenyan AIDS program

The US will give $2.7 million dollars of the PEPFAR money to Kenya. PEPFAR is short for the President's Emergency Plan for AIDS Relief. The PEPFAR program started by President Bush and is undergoing some restructuring under President Obama. Over a million people are living with AIDS in Kenya.

From Reuters, reporter Jeremy Clarke descibes the need for AIDS funding in Kenya.

The money, which is to be dispersed over the next five years, represents a 112 percent increase in funding for the programme in Kenya, east Africa's largest economy. It is seen by the United States as an enhancement of a successful programme.
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"Kenya is now the biggest recipient of this programme in the world, more than South Africa," U.S. Ambassador Michael Ranneberger told reporters in Nairobi.

He said the agreement with Nairobi meant the government was expected to increase direct budget support for the fight against HIV/AIDS by a minimum of 10 percent annually.
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The programme will include caring for more than 550,000 orphans and vulnerable children, as well as helping manage other related co-infections such as Tuberculosis, Kenyatta said.

Sub-Saharan Africa accounts for 72 percent of the world's AIDS-related deaths with 1.4 million last year, while an estimated 1.9 million people in the region were newly infected with HIV.

A critique of PEPFAR

A story from McClatchy Newspapers today claims that policies under the US Bush administration helped to fuel the population boom in Africa.

During the Bush years the PEPFAR initiative began to provide drugs to those who are HIV-positive in Africa. However, the program did nothing to provide contraceptives to help slow the spread of the virus. Further, funding for family planning slowed during the Bush years.

The story makes the case that even though PEPFAR saved lives, the population boom made resources scarce for those lives to survive.

From McClatchy Newspapers, writer Shashank Bengali explains what effect the policy shift had on Africa's population.

Under President George W. Bush, the United States withdrew from its decades-long role as a global leader in supporting family planning, driven by a conservative ideology that favored abstinence and shied away from providing contraceptive devices in developing countries, even to married women.

Bush's mammoth global anti-AIDS initiative, the President's Emergency Plan for AIDS Relief, poured billions of dollars into Africa but prohibited groups from spending any of it on family planning services or counseling programs, whose budgets flat-lined.

The restrictions flew in the face of research by international aid agencies, the U.N. World Health Organization and the U.S. government's own experts, all of whom touted contraception as a crucial method of preventing births of babies being infected with HIV, the virus that causes AIDS.

The restrictions flew in the face of research by international aid agencies, the U.N. World Health Organization and the U.S. government's own experts, all of whom touted contraception as a crucial method of preventing births of babies being infected with HIV, the virus that causes AIDS.

The Bush program is widely hailed as a success, having supplied lifesaving anti-retroviral drugs to more than 2 million HIV patients worldwide.

However, researchers, Africa experts and veteran U.S. health officials now think that PEPFAR also contributed to Africa's epidemic population growth by undermining efforts to help women in some of the world's poorest countries exercise greater control over their fertility.

"It was a huge missed opportunity to integrate HIV/AIDS and reproductive health in ways that made sense," said Jotham Musinguzi, a Ugandan physician who heads the Africa office of Partners in Population and Development, an intergovernmental group that promotes sexual health in developing countries.

In some countries that received substantial PEPFAR funding, such as Uganda and Kenya, health surveys have found that fertility rates remained constant or even rose slightly over the past decade. In Uganda, where many men want large families and abortion is illegal except to save a woman's life, the average woman bears 6.7 children, one of the highest rates in the world.

This small nation of rolling hills and banana trees is at the epicenter of Africa's demographic boom. Uganda is roughly the size of Nebraska, but in 40 years its population is projected to triple to 96 million, surpassing Japan, according to the Population Reference Bureau, a Washington research center.

Stanching that tidal wave will require a dramatic increase in contraceptive use, currently practiced by only 18 percent of married women.

"There hasn't been a country in the world where the birth rate came down without it," said Carl Haub, a senior demographer with the population bureau.

Changes to PEPFAR AIDS program announced

On World AIDS Day, the Obama Administration hinted at some changes to the PEPFAR AIDS program. The President's Emergency Plan for AIDS Relief has provided drugs to hundreds of thousands of HIV-positive people in the under-developed world.

Management of the program has been controlled by US universities and charities, now the Obama administration wants to hand off management of the program to the countries that receive the drugs. This plan is proposed despite the fact that most of these countries do not have AIDS drug programs in place or are prone to corruption.

From the Washington Post, David Brown details the proposed changes to PEPFAR.

In an outline of a new direction for the global program started by President George W. Bush, the administration hopes to begin handing off day-to-day management of AIDS prevention and treatment programs to the 15 countries where $19 billion has been spent since 2004. The goal is to make the services a routine part of each nation's health offerings.

The program provides AIDS drugs, HIV counseling and testing, prevention advice and condoms, palliative care for people with advanced AIDS, and support for orphaned children. The services have been delivered through a complicated tiered system that includes American universities, international nonprofit organizations, government health ministries and hundreds of charities.

Under a strategy described in documents released Monday, the countries' health ministries would assume the task of delivering services -- which many already do -- as well as managing all the programs and measuring their effect.

Most of the funding, however, would continue to come from the United States, foreign donors and the Global Fund to Fight AIDS, Tuberculosis and Malaria.

"It is our honest belief that these programs are in a fragile period," said Eric Goosby, the U.S. global AIDS coordinator. "We need to transition them into being more embedded in the countries' infrastructure and for the countries to have true ownership of them."

Since its inception, the program -- run out of the State Department and known by its acronym, PEPFAR -- has helped provide antiretroviral treatment to 2 million people, supported the care of 10 million (including 4 million children in families affected by AIDS) and been at least partly responsible for the fact that 240,000 babies born to HIV-positive mothers did not have the infection.

Some announcements from the US on World AIDS Day

On this World AIDS Day, the US government held a press conference that made several announcements. First of all, the World AIDS Conference will come to Washington in 2012, the first time it has been held in the US since 1990. Reuters also reports that the Obama Administration will lift the ban on people entering the US that are HIV positive.

Finally, changes will be announced to PEPFAR, the initiative to provide emergency vaccines to those with AIDS in the under-developed world. President George H W Bush began the program, now the Obama administration would like to make some changes to PEPFAR.

Those changes are the focus of our snippet for this post, Reuters reporter Andrew Quinn found out what the changes may entail.

Eric Goosby, President Barack Obama's global AIDS coordinator, said he would announce later this week a five-year strategy for PEPFAR that would see the emphasis shift from emergency interventions such as providing drugs to longer-term efforts to improve basic healthcare services.

Goosby said his review would include details of how PEPFAR will work with international partners and recipient governments to improve healthcare delivery and address stigma and discrimination in a "global response to a global responsibility."

The AIDS virus infects 33 million people globally and about a million in the United States, but more people are living longer thanks to HIV drugs, according to a recent U.N. report.

But more than half the people who need lifesaving drugs are not getting them, the World Health Organization and Joint U.N. Program on HIV/AIDS say.

Cocktails of drugs can control HIV but there is no cure and no vaccine.

PEPFAR, the President's Emergency Plan for AIDS Relief, has been credited with helping to cut AIDS deaths by 10 percent in targeted African nations and saving more than a million lives, in large part by supplying HIV drugs.