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Africa Health News July-Aug 2008

Africa Health News July-Aug 2008

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e US Senate voted overwhelmingly in July to commit $48 billionover the next five years to the global fight against HIV/AIDS, tuber-culosis and malaria. e legislation, which builds on the President’sEmergency Plan for AIDS Relief (PEPFAR), is the most ambitiousforeign public health program ever launched by the United States.
Senate approval is the last major obstacle to the bill’s becoming law.It is targeted to prevent 12 million HIV infections and treat three mil-lion people over five years. It also seeks to address Africa’s severe healthworker shortage by supporting countries in developing long-termhealth workforce plans and by funding the training of 140,000 newhealth workers.Since passage in 2003, PEPFAR has helped bring lifesaving antiret-roviral drugs to about 1.7 million people and has supported care fornearly 7 million, including about 2.7 million AIDS orphans and vulner-able children. It has also provided HIV testing and counseling to about33 million people. Before the program began, only 50,000 people in allof sub-Saharan Africa were receiving anti-retroviral therapy.e Senate bill differs from the version passed by the US House of Representatives in April in several respects. In an amendment agreed to just hours before the final vote, the Senate agreed to set aside $2 billionof the $50 billion designated in the original bill to fund American In-dian water, health and law enforcement programs. e bill also reversesa 21-year-old law that bans most foreign visitors who are HIV-positivefrom entering or gaining permanent residence in the US.In a concession to conservatives who feared that money earmarkedfor prevention programs would be used by abortion providers, the Sen-ate bill requires that more than half of the program’s bilateral aid goto AIDS treatment and care and avoids the requirement contained inthe House version that 20% of the money go to HIV prevention activi-ties. e Senate version also does not include the clause included in theHouse bill authorizing family planning groups to provide education,testing and condoms.e Senate bill provides $10 billion - $2 billion a year - to the GlobalFund to Fight HIV/AIDS, Tuberculosis and Malaria. About $4 billionwill be spent on fighting TB, the leading cause of death among thosesuffering from AIDs, and $5 billion on combating malaria.Eager to send the bill to President Bush for his signature, the HouseForeign Affairs Committee has said it would accept the Senate versionand the full House will take up approval of the legislation before Con-gress goes into summer recess at the end of July.Sen Richard Lugar (R-Ind), the top Republican on the Senate ForeignRelations Committee, credited PEPFAR with helping to prevent insta-bility and societal collapse in several at-risk countries. In addition, hesaid, the program had “facilitated deep partnerships with a new genera-tion of African leaders, and it has improved attitudes toward the UnitedStates in Africa and other regions.
 A red ribbon adorns the White House in recognition of World  AIDS Day and the US commitment to fighting AIDS globally.
Nearly 3 million people in low- and middle-income countries werereceiving antiretroviral therapy (ART) by the end of 2007, accordingto a report released in June by World Health Organization (WHO),UNAIDS and UNICEF.
e report,
Towards Universal Access: Scaling up Priority HIV/AIDSInterventions in the Health Sector,
also documented improved accessto interventions aimed at preventing mother-to-child transmission of HIV, expanded testing and counseling, and greater country commit-ment to male circumcision in heavily-affected regions of sub-SaharanAfrica.“is represents a remarkable achievement for public health,” WHODirector-General Dr. Margaret Chan said. “is proves that, with com-mitment and determination, all obstacles can be overcome. People liv-ing in resource-constrained settings can indeed be brought back to eco-nomically and socially productive lives by these drugs.Reaching the 3 million figure represented a milestone for globalagencies fighting HIV/AIDS because that was the target sought by theend of 2005. Although that target was not met until two years later, itwas credited with jump-starting the effort towards sc
aling up ART.Meeting the target, the report stated, can be attributed to increasedavailability of d
rugs due to price reductions, improved ART delivery systems that are now better adapted to country contexts, and increaseddemand for ART as the number of people testing positive for HIVclimbs.e report estimated that about 31% of the estimated 9.7 millionpeople in need of ART received it by the end of 2007. Nearly 500,000women were able to access ART to prevent transmission to their un-born children - up from 350,000 in 2006. Some 200,000 children re-ceived ART in 2007, compared to 127,000 at the end of 2006.
While acknowledging the enormous advanc-es made in the care and treatment of thoseinfected by HIV/AIDS, delegates gathered inKampala in June for the 2008 HIV/AIDS Im-plementers’ Meeting called for much stron-ger programs to prevent transmission of the virus.
“We need to acknowledge that HIV preven-tion is chronic disease management just astreatment is,” US Global AIDS CoordinatorAmbassador Mark Dybul told the gathering of 1,700 HIV/AIDS program implementers fromaround the world.“We must walk with people from the timethey are very young to the time they are beyondrisk, keeping messages and methods fresh andalive, to tackle sexual behavior like we tackledsmoking, to make it cool and a part of societalexpectations for individuals to practice socially responsible behavior, to make gender violenceand gender inequality not only uncool but un-acceptable,” Ambassador Dybul said.“We need to develop combination preven-tion to parallel the intensity, focus, and suc-cess of combination antiretroviral treatmentintegrating social and behavioral change withproven sc
ientific and medical methods,” headded.While 3 million people in low and middleincome countries are now receiving antiret-roviral treatment, the World Health Organi-zation (WHO) estimates that for every twopeople who are newly put on treatment, fivebecome infected. And, Dr. Peter Piot, Execu-tive Director of UNAIDS told delegates, while87% of countries in the world have establishedclear and ambitious goals for HIV treatment,only about 50% have targets for key HIV pre- vention strategies.In addressing the theme of the meeting,“Scaling Up Through Partnerships: Overcom-ing Obstacles to Implementation,” speakerspointed to the need to forge more concretelinks across the board to improve health sys-tems generally and to place more responsibil-ity in the hands of government and local au-thorities.“Moving out of a failed and flawed era of donors and recipients, we are entering a newera in development based on partnership be-tween equals,” Ambassador Dybul s
aid. “Onein which we, the international partners, mustacknowledge our role as the junior partner tothe countries we are privileged to support.One area highlighted by those attendingthe meeting was the need to understand thedynamics of local AIDS epidemics and tailorresponses to specific situations. Dr. Piot de-scr
ibed this as “making the money work forpeople on the ground.”“There are still many areas where we canstrengthen local ownership, reduce unit costsof delivery, improve coordination and increaseaccountability,” he said.Dr. Tom Kenyon, Principal Deputy andChief Medica
l Officer in the Office of theGlobal AIDS Coordinators, pointed to the bestresults occurring when there is good coordina-tion at the country level between developmentpartners around a national plan.“This is where our resources achieve thegreatest results, when we are led by the hostcountry with a shared vision and shared goals,leadership and country ownership, transpar-ency on both sides, and trust and mutual re-spect,” he said.During the five-day conference, which be-gan on June 4, more than 200 papers werepresented by delegates from governments,NGOs, including faith- and community-basedgroups, multilateral organizations, the privatesector and groups representing people livingwith HIV/AIDS.Despite the challenges posed by the chang-ing face of the epidemic
, it was agreed thatthere were many past successes upon whichto build. Addressing the opening session, Am-bassador Dybul told the delegates, “You haveirrevocably shattered the pernicious and par-ternalistic myth that people in resource-poorcountries could not manage complex chronicprevention, care, and treatment programs ona national and, in fact, continental scale. Andin so doing, you have created new models andlessons learned for development overall.”For transcripts from the 2008 Implement-ers’ Meeting go to: www.kaisernetwork.org/hivimplementers2008.
Ugandan President Yoweri Museveniand Mrs. Janet Museveni at the meeting 
e Global Health Initiative of the WorldEconomic Forum and the Lilly MDR-TB(multidrug-resistant tuberculosis) Partner-ship launched a new toolkit in June to boostthe involvement of South African companiesin tackling the country’s tuberculosis (TB)crisis.
Developed with inputs from national andinternational partners including the privatesector, the toolkit provides concrete guidelinesto help South African companies rapidly in-crease their TB control programs by adoptinga joint approach to diagnosing and treating thegrowing number of TB patients who are alsoHIV positive.With 70% of TB patients also infected withHIV, South Africa now accounts for 28% of HIV-TB positive cases worldwide. Takenwith the emerging threat of fatal drug-resis-tant strains of the disease, the Government of South Africa has recognized the importance of engaging the private sector in achieving its TBcase detection and treatment targets.“Businesses have a fundamental responsi-bility towards both their employees and thewider community, and for preservation of their long-term interests by ensuring the na-tional development of human capital to driveeconomic growth,” said Mr. Alex Azar, EliLilly and Company’s Senior Vice-President forCorporate Affairs and Communications. “Tu-berculosis has the capacity to undermine all of this.”e TB toolkit aims at intercepting the pro-gression of the disease by giving businessesguidelines that help them leverage their exist-ing health infrastructures and managementtools and resources to greater effect. It willalso help companies increase opportunitiesand activities in the prevention, diagnosisand treatment of TB/HIV co-infections in theworkplace.Eli Lilly and Company launched the Lilly MDR-TB Partnership, an alliance of 14 publicand private organizations, in 2003. It providescomprehensive services for individuals andfamilies afflicted with MDR-TB - diagnosis,treatment and surveillance of patients; train-ing of doctors and nurses; community sup-port, patient advocacy and anti-stigma effortsin the workplace; and transfer of Lilly d
rug-manufacturing technology to pharmaceuticalcompanies in high-burden MDR-TB countriesto increase local drug supplies.
e Global Business Coalition (GBC), an alliance of more than 225international companies, announced in June an unprecedented pack-age of private sector initiatives aimed at “turning the corner” in thefight against HIV/AIDS, tuberculosis and malaria.
e pac
kage includes a GBC-United Nations health-action roadmapfor optimal cross-sector coordination, a plan led by New York StockExchange (NYSE) Euronext to tighten integration of business into themalaria fight, and the deployment in Africa of a series of critical actionteams to identify ways that corporations can coordinate their skills andresources to maximize their impact on Africa’s health challenges.Speaking on June 9 at GBC’s 2008 Gala and Awards for Business Ex-cellence in New York, Mr. John Tedstrom, Executive Director of GBC,the private sector arm of the Global Fund to Fight AIDS, Tuberculosisand Malaria, said
, “e evolution of business’ role as an active par
tnerin the fight has reached a point at which a major, world-changing break-through is possible.”e aim of the new package, Mr. Tedstrom said, was to move away from isolated partnering to globally- and nationally- coordinated part-nering by more effectively matching specific business infrastructureand skills to gaps in the fight, and by engaging business more actively on the ground.“My message: Seize the moment. e way to do this is coordination- smart, strong partnerships at all levels. And make those partnershipswork,” he added.e roadmap, to be delivered to the UN Secretary-General Ban Ki-Moon on World AIDS Day 2009, will chart the way to a cost-effec-tive, results-intensive strategy. “It will identify the gaps in technology,res
ources, infrastructure, and know-how that business can, in concertwith key partners, fill and, in so doing, make the right difference in theright places at the right time,” Mr. Tedstrom said.NYSE Euronext, the world’s largest exchange group and a world lead-er for listings, cash equity trading, derivatives and the distribution of international ma
rket data, joined GBC in April and co-hosted a WorldMalaria Day event with GBC and the UN Foundation that focused onthe importance of cross-sector collaboration to achieve the goal of elim-inating malaria mortality by 2010.Working with GBC, the UN Foundation and the NGO, Malaria Nomore, NYSE Euronext has commited to ensure that more than 10 mil-lion insecticide-treated bed nets will be dispensed as quickly as possibleto all those living in areas most affected by malaria.GBC’s first critical action team will be deployed to Kenya within thenext three months. In June, the coalition signed a strategic partnershipwith the government of Kenya that will allow GBC, in partnership withmember companies and AMPATH (the Academic Model for the Pre- vention and Treatment of HIV/AIDS)
, to dramatically increase HIVtesting by going to the homes of more than 2 million Kenyans who willalso be sc
reened for TB and provided with anti-malaria bed nets andmedications for intestinal worms.GBC’s 2008 Gala and Awards for Business Excellence brought to-gether private sector leaders with major partners in the fight includ-ing UN Secretary-General Ban and other top UN officials, Global FundChairman of t
he Board Mr. Rajat Gupta and Executive Director MichelKazatchkine, Ministers of Health from a host of countries includingAngola, Benin, Cote d’Ivoire, Kenya, Lesotho, Liberia, Namibia, SouthAfrica, Swaziland, Sudan and Tanzania
, and the First Ladies of Rwanda,Sudan and the Republic of Georgia.
e GBC Awards for Business Excellence were earned by compa
niesthat, in GBC’s view, had demonstrated extraordinary commitments, ac-tions and results.
 HIV/AIDS: Leadership
for leveraging its media platformsto communicate critical health messages globally.
 HIV/AIDS: Community Philanthropy 
Intesa Sanpaolo
forcreating Project Malawi in partnership with local government andNGOs
 HIV/AIDS: Women & Girls
Johnson & Johnson
for providingcomprehensive services in South Africa to prevent mother-to-childHIV transmission.
 HIV/AIDS: Comprehensive Workplace Programs
StandardBank Group
for its workplace policy to encourage employees andtheir families to know their HIV status and to reduce the stigmaassociated with HIV/AIDS.
 HIV/AIDS: Workplace Testing & Counseling 
Telekom S.A.Ltd.
for its Thuso HIV/AIDS Workplace program in South Africawhich provides education, awareness, testing and treatment.
 HIV/AIDS: Expanded Community Initiatives
Xstrata CoalSouth Africa
for its comprehensive community program inMpumalanga province to combat HIV/AIDs, tuberculosis and otheropportunistic infections.
 HIV/AIDS: Core Competence - BBC World Service Trust
for itsHIV/AIDS media campaign in India which has reached more than250 million people.
 Excellence on Tuberculosis
BD (Becton, Dickinson Company)
for its initiative to improve diagnostics for tuberculosis in thedeveloping world.
 Excellence on Malaria
Exxon Mobil Corporation
for its AfricaHealth Initiative which focuses on malaria research, community disease control and community advocacy.
ExxonMobil won the GBC Award for Business Excellence on Malaria

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