Treatment Gaps Threaten Zimbabwe’s AIDS Success Story

Washington DC, US – Zimbabwe’s AIDS success is under threat due to funding gaps for anterotroviral (ARV) drugs which threatens to affect almost 70,000, according to a report issued by Medicens Sans Frontieres.

The report stated that national ARV buffer stocks are currently being depleted to cover some of the shortages. The country is already eating into its allotted Global Fund money to cater for the current treatment gaps, a scenario that will result in an estimated 428,068 people eligible for treatment unable to access ARVs by 2014.

While the country has recorded major success with ARV coverage growing from five per cent in 2006, to 77 per cent among adults and 39 per cent among children, there is a danger that the lives of 435,000 adults and 41,000 under treatment could be put in jeopardy.

According to the MSF report, Zimbabwe’s AIDS levy currently pays for over 25 percent of its ARVs, it has not yet been possible to close the treatment gap.

“The immediate funding gaps in Zimbabwe are due to the transitioning out of a pooled donor fund (the Expanded Support Programme) by the end of 2011. Funding for ARVs was not part of the new basket fund initiative (Health Transition Fund), as the assumption was that providing ARVs for the supproeted ARV cohort would be done with domestic and Global Fund to Fight AIDS, Tuberculosis and Malaria (GFATM) support,” stated the report.

The report added that donors such as US President’s Emergency Fund for AIDS Relief (PEPFAR) and the Department of International Development (DfID) are now trying to help close the HIV treatment gap. But most of these efforts will not be felt until later this year or early next year putting many people’s lives at risk.

“The GFATM will need to address a significant part of this shortfall, while additional funds to continue initiating new patients on ARV treatment also need to be ensured,” read part of the report.

“Zimbabwe has played a key role in changing the face of the epidemic in the region and globally. Right now, all of Zimbabwe’s success are under serious threat due to the treatment gaps, and that’s why PEPFAR must channel the bulk of its funds towards this urgent priority,”said Chamunorwa Mashoko, an community activist and one of AVAC’s 2012 HIV Prevention Research Advocacy Fellow.

HIV/TB Advisor for MSF in Southern Africa, Dr Eric Goemaere, said that increased global funding is still required in the fight against the epidemic.

“Globally we’re finally past the halfway mark with HIV treatment. Health ministries are working hard to implement latest treatment recommendations and policies to get ahead of the wave of new infections, but they can’t do it alone. We need to see a dramatic increase in global support to fight this plague,” he said.

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Rectal Microbicides Seen As Key in Preventing New HIV transmissions

By Chief K.Masimba Biriwasha | Global Editor At Large

Washington DC, US – Unprotected anal sex is a key driver of HIV transmission in many parts of the world. The practice is surrounded with much stigma and discrimination which is a key barrier to developing protective measures.

Microbicide research has gained momentum in recent years with focus largely on products to prevent HIV transmission during vaginal sex. However, there is a growing momentum to develop rectal microbicides for women, men, and transgender individuals around the world who engage in anal intercourse.

Rectal microbicides are products – that could take the form of gels or lubricants – being developed and tested to reduce a person’s risk of HIV or other sexually transmitted infections from anal sex. In spite of the public health need for rectal microbicide research, there is serious institutional, socio-cultural and political stigma around the issue.

According to estimates, the risk of becoming infected with HIV through anal sex is 10 to 20 times greater than vaginal sex because the rectal lining, the mucosa, is thinner and much more fragile than the lining of the vagina.  Because the rectal lining is only one-cell thick, the virus can more easily reach immune cells to infect.

Against this background, developing safe, effective, affordable rectal microbicides is key priority to turning the tide against HIV among populations that engage in anal sex, said Dr Ian McGowan, a leading rectal microbicide researcher.

“We are moving through the early and middle phases of the development of a rectal microbicide,” McGowan, adding that funding is part of the science and that more researchers are required as the research unfolds.

“We need mo people engaged, we need communities to take up the issue – we should follow the science.”

Jim Pickett, Chair of the International Rectal Microbicide Advocates (IRMA) and Directyor of Advocacy at AIDS Foundation of Chicago said that funding for rectal microbicides remains a key challenge for developing rectal microbicide. Pickett said that a total of US 100 million is required to engage in the next phase of studies.

“What is important in developing the next phase of studies is to develop a product that is about pleasure, intimacy, connection, emotion and love. The tools that are out there do not adequately fulfil this need,” he said. “Making the rectal microbicide safe, effective, affordable and acceptable for all who need them is a key priority.”

AIDS Vaccine Advocacy Coalition (AVAC) Executive Director, Michael Warren, said that money dedicated to rectal microbicide has been a blip on the map and a more strategic approach is required to attract additional resources.

“We need to articulate what exactly is required for the rectal microbicides; we need to build a comprehensive ask for what is required. It must come with a specific plan so that it does not appear like we are requesting for a blank. We need a clear strategy described scientifically and costed effectively in order to get support,” said Warren.

 

Carol Odada, a Kenyan AIDS activist said that rectal microbicides were not an innovation limited to men who have sex with men only.

“HIV has a woman’s faces, a woman is the main victim but nobody thinks. Every other prevention is other. Every prevention works differently works differently. There is a lot of anal sex going around. It’s unfortunate that some women are forced to engage in anal sex. Rectal micorbicide is not a gay issue. Women have to drive the call for rectal microbicide,” she said.

Rectal Microbicides Open New Frontier in Turning HIV Tide

By Chief K. Masimba Biriwasha | OpEd

Microbicide research has gained momentum in recent years with focus largely on products to prevent HIV during vaginal sex. However, there is a growing momentum to develop rectal microbicides for women, men, and transgender individuals around the world who engage in anal intercourse.

Microbicides are products designed to prevent or reduce the sexual transmission of HIV or other sexually transmitted infections when applied inside the vagina or rectum. Most vaginal microbicides are being tested as gels or rings, while rectal microbicides are primarily being tested as gels.

Rectal microbicides are products – that could take the form of gels or lubricants – being developed and tested to reduce a person’s risk of HIV or other sexually transmitted infections from anal sex. In spite of the public health need for rectal microbicide research, there is serious institutional, socio-cultural and political stigma around the issue.

According to estimates, the risk of becoming infected with HIV through anal sex is 10 to 20 times greater than vaginal sex because the rectal lining, the mucosa, is thinner and much more fragile than the lining of the vagina.  Because the rectal lining is only one-cell thick, the virus can more easily reach immune cells to infect.

Although the rate of new infections is stabilizing in many countries around the world, HIV continues to disproportionately affect racial minorities and men who have sex with men. It is estimated that five to ten percent of the world’s population engages in anal sex.

Globally, men who have sex with men are 19 times more likely to be infected with HIV than the general population. Unprotected anal sex is the primary driver of the HIV epidemic among this population.

For decades, the primary approach to HIV prevention for anal sex has been consistent and correct use of male condoms. Male condoms are an extremely effective method to prevent HIV, but many people are unable or reluctant to use them.

Rectal microbicides are products – that could take the form of gels or lubricants – being developed and tested to reduce a person’s risk of HIV or other sexually transmitted infections from anal sex.

If proven effective, rectal microbicides could protect against HIV in people who are unable or reluctant to use condoms. Unlike condoms, they could provide an alternative way to reduce risk that is not controlled by one’s sexual partner and possibly enhance sexual pleasure, helping to motivate consistent use.

Rectal microbicides could offer both primary protection in the absence of condoms and back-up protection if a condom breaks or slips off during anal intercourse. Such an alternative is essential if we are to address the full spectrum of prevalent sexual practices and the basic human need for accessible, user-controlled HIV and STD prevention tools

Rectal microbicides research is in the early phase of clinical development due in part to scientific challenges related to the biology of the rectum, and cultural reluctance to address anal sex.

Most critically testing the safety and acceptability of microbicides designed specifically for rectal use is key to ensuring their effectiveness in preventing HIV infection among people who engage in anal sex.

Researchers need to first be sure rectal microbicides are safe and then conduct additional studies to find out whether they are effective against HIV.

Gender Based Violence Drives HIV Epidemic Among Women: US Study

By Chief K.Masimba Biriwasha | Global Editor At Large

Washington DC, US – One out of every four people living with HIV in the US is a woman according to a new study by the University of California, San Fransisco (UCSF). Further, it is estimated that 30 percent of women living with HIV in the country experience post traumatic stress disorder compared to 5,2 per cent in the general population.

The study has broad implications to efforts to turn the tide against the AIDS epidemic across the world in that its expected to shape the discussion on the impact of violence on women’s vulnerability to the disease.

“Women are dying unnecessarily. They can live with HIV, but are dying from the effects of violence in their homes and communities. HIV policies and programmes must prevent and address the effects of gender based violence that weave through women’s lives,” said Gina Brown, a woman openly living with HIV.

 

According to the study, which focused on approximately 6,000 women living with HIV, intimate partner violence is a disproportionately high cause of death for HIV positive women in the US.

The study concluded that traumatized  women fare worse in AIDS treatment more than women who have not suffered traumatic stress. Trauma also puts women in situations where they are more likely to spread the virus.

“For a long time we have been looking for clues as to why so many women are becoming infected with HIV and why so many are doing so poorly despite availability of effective treatment. This work clearly shows that trauma is a major factor in the HIV epidemic among women,” said Edward Machtinger, Director of the Women’s HIV Programme at UCSF in an interview.

Specifically, the study demonstrated that HIV positive women who report recent trauma had more than four times the odds of experiencing virologic failure, a situation where the HIV virus becomes detectable in the blood despite being on antiretroviral mediations.

The study also revealed that women who had suffered recent trauma were almost four times more likely to have had sex with someone without the virus or whose HIV status was unknown to them, and to not always use condoms with these partners.

“Women who report experiencing trauma often do not have the power or self-confidence to protect themselves from acquiring HIV. Once infected, women who experience ongoing abuse are often not in positions of power to effectively care for themselves or to insist that their partners protect themselves. Effectively addressing trauma has the potential to improve the health of HIV positive women and that of the community.”

Zimbabwean, Annah Sango, to Speak at AIDS 2012 Official Opening in US

Washington DC, US – Zimbabwean community activist, Annah Sango, will speak alongside world leaders at the official opening of the International AIDS Conference 2012 in Washington DC on Sunday.

Sango is a peer educator and role model to other young women in Bulawayo, Zimbabwe. She is a member of the International Community of Women Living with HIV and AIDS (Southern Africa) and founded her own community-based support group for women affected by HIV.

“Young people need to move from being passengers to drivers, sexual reproductive health rights are fundamental to everyone the sooner we appreciate that the closer we get to making a difference in the lives of women and young people,” said Sango, a trainer of trainers on issues facing young people.

Sango is a tireless advocate for the reproductive and sexual health rights of young women living with HIV throughout her region, including ensuring their access to woman-initiated prevention options like female condoms.

GlobalPOWER Women Network Africa Conference Opens in Harare

By Chief K.Masimba Biriwashs | iZiviso Global Editor At Large

HARARE, Zimbabwe – Women parliamentarians, leading African women entrepreneurs, civil society leaders, and development partners from Africa are meeting in Harare over the next two days for the inauguration and launch of the GlobalPOWER Women Network Africa.

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The conference, being attended by approximately 300 participants, is aimed at providing a strategic political platform to accelerate game changing approaches to HIV prevention and sexual and reproductive health and rights responses for women and girls. The idea to create an Africa-specific GlobalPOWER Women Network stemmed fom a September 2010 meeting in Washington DC that saw prominent female decision makers come together alongside their US peers to discuss how to accelerate the implementation of the UNAIDS Agenda for Women and Girls.

Participants at the conference are expected to address the key issues affecting girls and women in Africa including eliminating new HIV infections among children, keeping mothers alive and maternal and child health. The meeting will result in the “Harare Call to Action” to advance women’s empowerment and gender equality through HIV and Sexual and Reproductive Health and Rights responses.

President of the GlobalPOWER Women Network Africa and Zimbabwe Deputy Prime Minister, Thokozani Khupe said that women must take an active role in ensuring their empowerment.

“To achieve the vision of zero new HIV infections, zero discrimination and zero AIDS-related deaths, it is critical to recognise women and girls as key agents in making this vision a reality – society has to invest in the health of women and girls,” Khupe said.

Addressing the conference, Zimbabwe President Robert Gabrial Mugabe said the launch of the network will take the issue of women’s emancipation and empowerment a step further.

Äfter the launch, the real work will begin and call for the same passion, unity of purpose and consistency in pursuing the goals which have characterized this Women’s Network thus far. Of particular note will be the challenge of giving unstinting support to women candidates of every hue and cry; of varying professional qualifications, driven by different talents and capabilities to realise their potential in the collaborative work of Global Power Women Network, the Africa Union and UNAIDS,”said Mugabe.

In Africa, women and girls carry a disproportionate burden of the HIV epidemic – they constitute 59 percent of all people living with the disease. To make matters worse, gender inequality compounded by gender-based vioence, increase women and girl’s risk of HIV infection.

Ëmpowering women and girls to protect themselves against HIV infection and gender-based violence is a non-negotiable in the AIDS response,”said UNAIDS Executive Director, Michel Sidibe.

Cervical Cancer Kills Women in Developing Countries

By Chief K.Masimba Biriwasha

CERVICAL cancer, caused by infection with some type of human papillomavirus (HPV), is the leading cancer-related cause of death among women in developing countries.

The disease affects an estimated 500,000 women every year and kills a nearly quarter million worldwide. Eighty percent of the cases occur in developing countries where women have limited access to screening and treatment services.

“Among the most tragic public health failures of the last decade are the preventable deaths of young women in developing countries from maternal mortality and cervical cancer,” says Sue J. Goldie, a professor in the Department of Health Policy and Management at the Harvard School of Public Health.

HIV positive women are significantly more susceptible to having an HPV infection turn into cervical cancer.

This is despite the fact that there are tools available that can reverse this trend. Many governments in the affected countries have not prioritized the problem of cervical cancer in their national and health programs.

“We are now facing unprecedented opportunities to prevent these unnecessary and tragic deaths. In fact, recent concerted efforts have been made to assemble, synthesize, and interpret the available data with an eye towards actionable steps, and to comprehensively reflect on what has worked and what has not,” says Goldie. “Moreover, researchers, public health scientists, and policymakers are beginning to engage with the distinct purpose of agreeing on the most promising strategic approaches to eradicating preventable deaths in women.”

In developing countries, the vast majority of women with cervical cancer are diagnosed in late stages of the condition, and usually have little chances for long-term survival. To make matters worse, treatment for cervical cancer is rarely available even where the condition has been diagnosed.

“Unlike most cancers, cervical cancer is preventable through screening to detect and treat precancerous lesions. A conventional screening program, based on the cytological examination of cervical smears, can require up to three visits: an initial screening visit, colposcopic evaluation of abnormalities, and treatment. In countries that have been able to achieve broad cervical cancer screening coverage using cytology at frequent intervals, deaths have decreased considerably,” says Goldie.

For many developing countries, especially in sub-Saharan Africa, where poverty is endemic, and where health systems are in a state of dilapidation, cervical cancer is killing more women than necessary.

“In the vast majority of resource-poor settings such screening programs have proven difficult to implement and sustain due to a lack of human, technical, and monetary resources, and often inadequate health infrastructure,” says Goldie. “Additionally, the requirement for multiple visits, together with the need to screen at frequent intervals, has made it impossible to implement and sustain widespread organized screening in most poor countries.”

There’s need for a greater awareness of the severity of cervical cancer among women in developing countries. Also, there’s need for low-cost interventions that can be applied over a wide-scale.