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Africa: Staying the Course on AIDS?
Mar 15, 2010 (100315)
(Reposted from sources cited below)
We must end the false dichotomy between prevention and treatment.
If we choose one over the other we will fail. We know from our
experiences in the 1990s, that if treatment isnt there, people will
not come to the health centers and doctors and nurses will not
stay. We know from our long experience that it is virtually
impossible to have successful public sector health and AIDS
treatment programs where some people get therapy and others in dire
need dont. - Dr. Peter Mugyenyi, Joint Clinical Research Centre,
Despite substantial successes, and new evidence that universal
access to treatment could make a sufficient contribution to
prevention to roll back the pandemic, the commitment to universal
access this year will clearly not be met.
Testimony to Congress, international meetings, and progress reports
released by the Global Fund to Fight AIDS, TB and Malaria this
month stress that critical decisions are coming up this year on
whether world leaders will continue the momentum in the fight
against AIDS. Only one-third of people in need of HIV treatment
worldwide receive it, while more than 10 million more people in
urgent need of life-saving HIV treatment wait. South Africa in
particular has made significant new commitments to expand
treatment, but among rich countries the political will to follow
through on commitments is problematic.
This AfricaFocus Bulletin contains the testimony to Congress by Dr.
Peter Mugyenyi, a press release from the International AIDS Society
on a meeting of AIDS activists and experts with U.K. International
Development Minister Gareth Thomas, and a press release on the
latest progress reports released by the Global Fund to fight AIDS,
TB and Malaria.
For previous AfricaFocus Bulletins on health issues, visit
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Testimony to Congress: House Committee on Foreign Affairs,
Subcommittee on Africa and Global Health. Thursday, March 11, 2010.
Peter N. Mugyenyi M.D.
Executive Director of Joint Clinical Research Centre, Kampala,
Thank you Chairman Payne and Ranking Member Smith for giving me the
opportunity to address this committee, whose work has created and
sustained the US global AIDS response.
PEPFAR has saved millions of lives in Africa. PEPFAR started at a
time when the AIDS crisis in Sub-Saharan Africa had reached a
catastrophic stage because timely action was not taken, and the
African countries were too overwhelmed by the sheer magnitude of
the disaster. Before PEPFAR, less than 100,000 thousand in Africa
had access to life saving antiretroviral drugs, and millions were
dying from what had become preventable deaths in rich countries.
Today, there are four million people on ARV treatment in low- and
middle-income countries. These people and their mothers, husbands,
wives and children got a chance to livemore than half of whom have
benefited from the U.S. governments contributions to PEPFAR and the
Beyond treatment, support for care and prevention efforts has
helped ease the carnage that I and my fellow health care providers
used to witness on a daily basis. It has been replaced by hope.
Recent evidence has shown that HIV programswhere they have reached
community-wide coverage--have been among the most effective
interventions having impact well beyond the AIDS epidemic.
Studies in Uganda have shown the increase in services for HIV/AIDS
was accompanied by a reduction in non-HIV infant mortality of 83%
as parents not only lived but thrived. The DART study, which I
co-chaired, found a 75% reduction in Malaria associated with
These programs have also strengthened our health system beyond
addressing HIV/AIDS. For instance, PEPFAR assisted my Institution,
the JCRC, to build the 7 laboratories that support nearly all of
the public clinics and train several thousand health care providers
now providing crucial services to both the public and private
sectors in Uganda.
This success has been coupled with real excitement at new evidence
that reaching all those in need of ARVs could help us stop new
infections and beat the epidemic for good. New data from Conference
on Retroviruses only a week ago, which I attended in San Francisco,
shows that HIV transmission between heterosexual couples in Africa
is reduced by 90% if the HIV-positive partner is on antiretroviral
therapy. This gives credence to recent modelling by the World
Health Organization that shows some of the first good news on
prevention in several years: that we could truly end the AIDS
crisis within a generation.
Today, however, a funding crisis threatens to reverse these highly
positive changes and we could miss the opportunity to defeat the
AIDS in much of Africa is still an emergency. It continues to be
the biggest killer of women of reproductive age in Africa. In
Uganda, we have come very farbut were less than half way there.
Only 170,000 adults out of estimated 350,000 in immediate need of
life-saving ART, and 12,000 children out of estimated 60,000 who
need treatment, are receiving it now.
Unfortunately, over the last two years, PEPFAR funding has
flat-lined. New PEPFAR contract awards emphasize treatment for only
those already on it and only very limited slots for new patients
Currently, my institution, which pioneered antiretroviral therapy
in Africa and treats a large proportion of AIDS patients in Uganda,
is not taking new patients due to lack of funding. We are forced to
turn away desperate patients dailyoften 15 to 20. And most of those
who come to us will have been turned away from a number of other
When I say new patients, it is important to note that most of these
are not truly new. Thousands of Ugandans (and millions throughout
Africa) heard the messages from PEPFAR-funded programs that knowing
your HIV status was important to protect yourself and others, and
that treatment would be available to those that require treatment.
Even though we have put thousands of patients on PEPFAR-supported
care.today, my program and numerous others across my country cannot
deliver on the promise of treatment.
I have witnessed many desperate patients unable to access therapy,
including pregnant women, resorting to desperate and dangerous
measures including sharing drugs with their family members,
ignoring the good counselling they receive advising against this
Recently, an HIV-infected woman who was breastfeeding her
HIV-negative child because she could not afford formula milk came
to our clinic, having been turned away from three other clinics in
Kampala because they had no slots. She knew that every day she
breast fed her baby without being on treatment greatly increased
the chances of her child getting infected, but she had no
We at JCRC in Uganda led the early resistance testing studies which
found that treatment interruptionincluding sharing of drugs which
is becoming increasingly widespreadresult in drug resistance. This
will result in large numbers of patients failing on the simpler and
low-cost first-line drugs and needing more expensive and more
sophisticated second-line therapy.
We must end the false dichotomy between prevention and treatment.
If we choose one over the other we will fail. We must invest
simultaneously in treatment while also scaling up prevention
programs including male circumcision, combination prevention, and
services targeted for high risk groups.
Let us also not forget that strengthening the health system and
getting AIDS treatment to those who need it are not contradictory
goals. We know from our experiences in the 1990s, that if treatment
isnt there, people will not come to the health centers and doctors
and nurses will not stay. We know from our long experience that it
is virtually impossible to have successful public sector health and
AIDS treatment programs where some people get therapy and others in
dire need dont.
The news of President Obamas new Global Health Initiative was
received in Africa with great appreciation and enthusiasm. However,
to ensure maximum health benefits, we must build on past successes
and ensure sufficient new money is available for successful
integration of serious health issues. Otherwise, we risk going back
to the failed approaches of the 1990s that did not prioritize
provision of life saving drugs.
In conclusion, allow me to refer to repeated commitments by the
United States to universal access to AIDS services in UN
declarations and G8 communiqus, which caused great excitement and
expectation in Africa.
US, as a world's friend, came to the rescue of Africa at the time of
her greatest need. It is our hope that current efforts can be
strengthened so that one day we can achieve our shared goal of a
world free of AIDS.
Thank you again very much for this opportunity and to the American
people for their compassion and generosity.
Africa: Global Health Advocates and UN Officials Meeting at
Westminster Say U.K. and World Leaders Must Keep Their Promise to
More Than 10 Million People with AIDS Who Need Treatment
12 March 2010
International Aids Society (Geneva)
With Britain leading the way, G8 leaders pledged at the U.K.-led
Gleneagles G8 Summit in 2005 to achieve universal access to HIV
prevention, treatment and care by 2010. Significant progress has
been made in some areas yet, as the universal access pledge comes
due, only one-third of people in need of HIV treatment worldwide
receive it, while more than 10 million more people in urgent need
of life-saving HIV treatment wait. Most people living with HIV are
still unaware of their status. And fewer than half of pregnant
women living with HIV receive the drug regimen that can extend
their own lives and save their children from infection.
Worse, advocates and leaders meeting here point to worrying signs
that political and financial commitments to universal access are
faltering, just as they should increase. Funding for the Global
Fund to Fight AIDS, Tuberculosis and Malaria, an incredibly
successful mechanism that has saved nearly 5 million lives since
2005, is in jeopardy. Canada, host of this year's G8 and G 20
summits (25-27 June), has made little mention of universal access
and is now the only G8 nation firmly opposed to the U.K.-endorsed
Financial Transactions Tax (FTT), a tiny tax on financial
transactions that could raise the billions of Pounds needed to
fulfill the universal access pledge.
High-ranking civil society representatives, leading researchers and
African governments meeting today with U.K. International
Development Minister Gareth Thomas are calling on the U.K. to
strengthen its own action on universal access, and work to ensure
that the global pledge to achieve HIV prevention and treatment for
all is not forgotten at this year's G8 and G20 summits.
"More than 4 million people worldwide are receiving HIV treatment
-- an important achievement, but still far from meeting even the
most basic assessment of need," said Robin Gorna, executive
director of the International AIDS Society and facilitator of
today's meeting. "Yet, instead of building on progress, some donor
nations and governments of highly affected countries are backing
away from the universal access commitment with a series of poorly
funded half-measures on AIDS. The situation is now an emergency.
New treatment enrollments in many countries are coming to a
standstill, the risk of drug resistance is increasing, and fragile
gains made over the last 10 years may soon erode, with potentially
serious consequences for future efforts to control this epidemic."
"Evidence demonstrates the incredible positive impacts that come
from HIV treatment scale up," said International AIDS Society
President Julio Montaner. "Broad access to HIV treatment saves
lives and substantially reduces new HIV infections by lowering the
infectiousness of people with HIV. Well-programmed AIDS funding
strengthens health systems and expands access to essential health
services such as immunization and vaccination. Today we ask the
U.K. to not only redouble its efforts to achieve universal access,
but also to work to ensure that the universal access pledge remains
high on the global agenda -- at the G8 and G20 summits and beyond."
"This is a commitment we cannot break and a fight we cannot lose.
We are still far from reaching the level of care promised for
2010," said singer and AIDS campaigner Annie Lennox. "It is
unacceptable that half of the pregnant women who needs drugs to
protect their own health and their babies cannot get them; that 10
million people in immediate need of treatment have no access.
Governments such as the U.K. that have taken significant action to
achieve universal access pledge must take a strong stand to
encourage those that lag behind to keep their promises on AIDS."
"The cost of providing universal access to HIV prevention and
treatment is a small fraction of the economic, human and social
costs of ignoring this epidemic," said Diarmaid McDonald, Stop AIDS
Campaign Coordinator. "The current economic slowdown cannot be an
excuse to overlook the universal access pledge. The U.K. was
instrumental in forging this global commitment. The U.K. must now
lead in efforts to ensure that it is met."
"It is shocking that 33 million people around the world are living
with HIV and that for every two people receiving treatment there
are five new HIV infections," International Development Minister
Gareth Thomas said. "The UK has consistently led the international
community in efforts to tackle HIV and remains fully committed to
getting the drive for universal access back on track. That is why
in 2007 the Department for International Development committed
landmark funding of 1 billion UK aid to the Global Fund for HIV, TB
and Malaria, and why we have called this meeting to look at what
more we can do collectively to increase progress on tackling HIV
"The goal of today's meeting is clear," said Asia Russell of the
Health GAP Global Access Project. "We need the U.K. to fully assume
its leadership role in ensuring that the G8 and G20 nations
recommit to achieving universal access to HIV treatment, prevention
and care, and to raising the additional resources needed to support
a comprehensive, quality global AIDS response."
Note to editors:
Today's high level meeting at the House of Commons includes the
- Professor Moses Chirambo, Minister of Health, Malawi
- Dr Alex Coutinho, Executive Director of Infectious Diseases
Institute, Makerere University, Uganda
- Vuyiseka Dubula, General Secretary, Treatment Action Campaign,
- Ambassador Eric Goosby, USA
- Robin Gorna, Executive Director, International AIDS Society
- Professor Rachel Jewkes, Director, Gender & Health Research Unit,
Medical Research Council, South Africa
- Dr Michel Kazatchkine ED, Global Fund to fight AIDS TB & Malaria
- Hon. Esther Murugi Mathenge, Minister for Gender, Children and
Social Development, Kenya
- Professor Narciso Matos Director of the Foundation of Community
Development (FDC), Mozambique
- Professor Julio Montaner, President, International AIDS Society
- His Royal Highness Chief Mumena, Zambia
- Rev Dr Nyambura Njoroge, Executive Coordinator of the Ecumenical
HIV & AIDS in Africa Initiative for the World Council of Churches.
- Nelson Otwona, NEPAK (National Empowerment Network of People
Living with HIV/AIDS in Kenya).
- Dr. Sam Phiri, Executive Director, the Lighthouse Trust, Malawi
- Dr Yogan Pillay, Deputy Director General Strategic Health
Programmes. Ministry of Health, South Africa
- Asia Russell, Health GAP
- Michel Sidibe, Executive Director UNAIDS
- Professor Alan Whiteside, HEARD /University of KwaZulu Natal
- Hon Benedict Xaba, Minister of Health & Social Welfare, Swaziland
Dramatic reduction in malaria deaths by 2015 possible;
on track to meet global TB targets
08 March 2010
Global Fund to Fight AIDS, TB and Malaria
[Excerpts only. For full press release and 2010 Progress Reports go
Geneva Virtual elimination of mother to child HIV transmission by
2015 is now within reach if current rates of progress by Global
Fund-supported programs and other efforts are maintained. Malaria
may be eliminated as a public health problem within a decade in
most countries where it is endemic. Tuberculosis prevalence in many
countries is declining and the international target of halving TB
prevalence could be met by 2015.
These are projections from the Global Funds 2010 Results Report,
released today. They are contingent on the current rate of scaling
up of health investments for the three diseases being at least
maintained and ideally accelerated further.
A world where no children are born with HIV is truly possible by
2015, says Professor Michel Kazatchkine, Executive Director of the
Global Fund. It is also possible now to imagine a world with no
more malaria deaths, since already an increasing number of
countries have been reporting a reduction in malaria deaths of more
than 50 percent over the past couple of years. No other area of
development has seen such a direct and rapid correlation between
donor investments and live-saving impact as these investments in
fighting AIDS, TB and malaria.
According to the report, Global Fund-supported programs saved at
least 3,600 lives per day in 2009 and an estimated total of 4.9
million since the creation of the Global Fund in 2002. These are
people who would otherwise be dead, had it not been for
interventions supported by the Global Fund.
The Global Fund is about getting results. This report clearly shows
the world's investments are making a difference, said Mr Michel
Sidib, Executive Director of UNAIDS. However AIDS is not over in
any part of the world and without a fully funded Global Fund, our
shared dream of universal access to HIV prevention, treatment care
and support could become our worst nightmareputting the lives of
millions of people currently on treatment in jeopardy and millions
of pregnant women in a position not able to protect their babies
from becoming infected.
The Results Report forms part of the documentation for donors in
preparation for the Global Funds replenishment conference in
October 2010 in New York, where the organization will ask donors
for financial contributions for 2011-2013. This is the third time
since the Global Fund was established in 2002 that donors are being
asked to replenish its finances.
At an initial Replenishment review meeting to be held in The Hague
on 24 March, the Global Fund is presenting three resource scenarios
for consideration to donors, each with an indication of the results
that could be expected in terms of achievements on the ground at
the end of the replenishment period. The different scenarios range
from US$ 13 to 20 billion for the three-year period.
By the end of 2009, Global Fund-supported programs provided
antiretroviral treatment to 2.5 million people, treatment to 6
million people who had active TB and had distributed 104 million
insecticide-treated nets to prevent malaria. In addition to
averting at least 3,600 deaths daily, the programs prevent
thousands of new infections and alleviate untold suffering and
economic loss for poor families in 144 countries.
Established as a public-private partnership to mobilize and
intensify the international response to the three global epidemics
and help achieve the UN Millennium Development Goals (MDGs), the
Global Fund has disbursed US $10 billion for HIV, TB and malaria
efforts through December 2009.
The coming years will see even more results, as half of the total
disbursements by the Global Fund were delivered in 2008 and 2009.
In addition, much of the US$ 5.4 billion of financing approved in
the last two rounds of proposals (8 and 9) will reach countries in
2010 and 2011, and will continue to significantly boost health
The progress in combating AIDS, TB and malaria as a result of these
investments has also had a positive impact on child mortality and
maternal health. The MDGs call for halting and reversing the major
diseases as well as reducing child mortality and improving maternal
health by 2015.
Global Fund grants have made significant contributions to reducing
the largest causes of mortality among women and children. This is
particularly the case in sub-Saharan Africa, where HIV, TB and
malaria are responsible for 52 percent of deaths among women of
childbearing age and malaria alone accounts for 16 to 18 percent of
Results by Disease, up to December 2009
- 2.5 million people are currently on antiretroviral therapy (ART),
a level of coverage deemed unattainable less than a decade ago.
- AIDS mortality has declined in many high-burden countries.
- The Global Fund contributed about one-fifth of all disbursements
by bi- and multilaterals for the HIV response in low- and
middle-income countries in 2008.
- 1.8 billion condoms distributed.
- 105 million HIV counseling and testing sessions provided.
- 790,000 HIV-positive pregnant women in low- and middle-income
countries received antiretroviral prophylaxis to prevent
mother-to-child transmission which represents 45 percent of
coverage of women in need.
- 4.5 million basic care and support services provided to orphans
and other children made vulnerable by AIDS.
- Around 6 million people with active TB were treated by December
- 1.8 million TB/HIV services provided a 150 percent increase
since the end of 2008, contributing to the decline of TB prevalence
and mortality rates in many countries.
- The Global Fund provides 63 percent of the external financing for
TB and multidrug-resistant TB (MDR-TB) control efforts in low- and
middle-income countries it is by far the major source of
international funding for tuberculosis.
- Today, countries are on track to meet the international target of
halving TB prevalence by 2015.
- 104 million insecticide-treated nets distributed to prevent
malaria; more than 19 million indoor residual spraying of
insecticides in dwellings; 108 million cases of malaria treated in
accordance with national treatment guidelines.
- An increasing number of countries reporting a reduction in
malaria deaths of more than 50 percent. At least ten of the most
endemic countries in Africa have reported declines in new malaria
cases and an impressive decline in child mortality of 50 to 80
- In 2008, the Global Fund contributed 57 percent of international
disbursements for malaria control which makes it, by far, the
major source of international funding for malaria.
- In Africa, Swaziland and some island states and territories are
now aspiring to enter the malaria pre-elimination stage.
Progress towards meeting Millennium Development Goals
The report points out that continued, substantial increases in
long-term financial commitments by donors will be needed to
consolidate the gains and to reach the MDGs by 2015.
Within that time-frame, 2010 is decisive.
Funds committed now will benefit programs which will have effect on
the ground from 2012 to 2015. The numbers show that countries are
approaching a positive tipping point: if they continue on this
path, the returns will be exponential and the world will reverse
the AIDS, TB and malaria epidemics.
In health, 2010 is a pivotal year to finance the final stretch of
the effort to reach the Millennium Development Goals, says
Professor Kazatchkine. We have made unprecedented progress but it
is fragile. If we lose momentum now there will be a heavy price to
pay. A failure to continue the scale-up of investments in health
will betray the trust of millions.
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