The U.S. President's Emergency Plan for AIDS Relief - July 2009 Newsletter

On July 20, 2009, Ambassador Eric Goosby, U.S. Global AIDS Coordinator, participated in a special session at the Fifth Annual International AIDS Society Conference on Pathogenesis, Treatment and Prevention in Cape Town, South Africa.

The special session, entitled “Global HIV Research and Policy and Programme Implementation under the New United States Administration,” was chaired by Professor Michel Kazatchkine, Executive Director of the Global Fund to Fight AIDS, Tuberculosis and Malaria, and the other presenter was Dr. Anthony S. Fauci, Director of the U.S. National Institute of Allergy and Infectious Diseases, part of the U.S. National Institutes of Health.

During his speech, Ambassador Goosby explained how the Obama Administration’s Global Health Initiative will shape the United States’ response to the global HIV/AIDS epidemic through the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR).

“The Administration’s Global Health Initiative will continue our country’s leadership on global health priorities like HIV, TB and malaria. But the idea is to expand the focus on integrating current programs with those that address maternal and child health, expand again into family planning and neglected tropical diseases. … we must commit to intensifying and invigorating our existing partnerships – and to cultivate new ones,” he said.

Ambassador Goosby also talked about the need to increase partner government ownership of the response to the HIV/AIDS epidemic.

“From an HIV/AIDS perspective, I believe we can and must scale-up our efforts to foster alliances that promote government buy-in and ownership in a more intense

Ambassador Goosby also emphasized the need to create sustainable programs and interventions.

“A critical goal of the Global Health Initiative – and a longstanding focus of PEPFAR – is the support for health systems strengthening. Continued and intensified investment in this area, including the health workforce, will be crucial to scaling up proven interventions and adding to the sustainability of PEPFAR and other health and development programs. … We need to take advantage of PEPFAR programs and data collection to rapidly define implementation strategies that work, or sometimes don’t work, to maximize positive outcomes. Building health systems to adequately respond to HIV/AIDS means systems that can better respond to other health issues as well. Those opportunities need to be indentified and engaged,” said Ambassador Goosby.

He also acknowledged that the United States Government, regardless of the current financial crisis, will remain committed to helping countries affected by the HIV/AIDS pandemic.

“We understand, and we really do understand, that the majority of countries hardest hit by the epidemic, especially during this economic downturn, are not able to assume every aspect of this role right now – particularly with respect to financing – nor will they be able to in the near future. But that does not mean that we can’t work aggressively with governments as supportive partners as they build their capacity to respond in responsible ways that meet the needs of individuals affected and infected, or who are at risk for HIV,” said Ambassador Goosby.

Additionally, he stressed throughout his presentation the importance of implementing effective, evidencebased prevention interventions and the need to address high-risk populations.

“We must improve our ability to work collectively to determine how to identify and disseminate effective behavioral, structural and biomedical interventions that converge on a given population over time. These prevention interventions need to be aggressive, continuous, and multifaceted, in order to succeed,” he said.

“Commercial sex workers, transgenders, injection drug users present different challenges in different cultures that require the development of special strategies that identify access points and retention strategies for these populations. This has to be an integral component of our care. For to forget to focus on those who do not easily reveal themselves to medical delivery systems creates an opportunity lost, but also a vulnerability for the continued transmission of HIV throughout the community,” said Ambassador Goosby.

This year, six-year old Binh Luom went to kindergarten. Binh, his older brother, and his mother live in a small community in northern Vietnam. His family faces stigma and discrimination because Binh and his mother are living with HIV/AIDS and because his father died of AIDS.

In 2004, when Binh was one year old, his mother submitted his application to attend kindergarten. School administrators rejected the application, citing an official regulation which states that children with infectious diseases can be excluded from school, at the discretion of school administrators.

However, Vietnam?s National Law on HIV/AIDS Prevention and Control explicitly states that educational establishments cannot refuse to admit students on the grounds that they are HIV-positive.

A lack of understanding of HIV/AIDS-related regulations and laws is one cause of stigma and discrimination against people living with HIV/AIDS (PLWHA) in Vietnam.

Beginning in 2008, Mrs. Luom received assistance from the Hanoi Legal Clinic, and thanks to their dedicated efforts, Binh?s kindergarten application was accepted and he reclaimed his right to education.

The Hanoi Legal Clinic is one of five clinics established in 2007 with support from the U.S. President?s Emergency Plan for AIDS Relief (PEPFAR) to provide legal assistance to PLWHA and others affected by the HIV/AIDS epidemic. The clinic?s legal staff advocate for the rights of PLWHA and reduction of HIV/AIDS-related stigma. With the clinic?s support, clients gain access to school, employment, and health care.

Mrs. Luom learned about the legal clinic when members of her PLWHA support group attended a communication session led by clinic staff.

Mrs. Luom said, ?Before I had the help of the Hanoi Legal Clinic, I went to the school alone four times?but the headmaster did not accept Binh?s kindergarten application.?

Hanoi Legal Clinic staff worked with teachers and administrators at the kindergarten to help them understand the law and to reduce HIV/AIDS-related stigma at the school. They also encouraged the Ministry of Health to work with the Ministry of Education and Training to clarify the regulation on infectious disease in schools and to ensure correct application of national HIV/AIDS laws at the provincial and local levels.

Binh?s case served as a catalyst for change: the Ministry of Education and Training issued a nationwide directive, requiring that all schools ensure the right of people living with and affected by HIV/AIDS to enroll in school and not be subject to HIV testing prior to acceptance.

To increase awareness of this directive, the Hanoi Legal Clinic conducted a training workshop for administrators and teachers from 28 of Vietnam?s 64 provinces, educating them about the directive and national HIV/ AIDS law.

Due to the clinic?s advocacy, not only is Binh now enrolled in school, but many other HIV-positive children across Vietnam who faced similar discrimination have also gained access to education.

?Binh would never have been able to go to school without the help of the Hanoi Legal Clinic? said Mrs. Luom, ?Absolutely.?

The children at Hawassa Children?s Center have waited a long time to start playing in and spending their nights at the new dormitory built with support from the U.S. President?s Emergency Plan for AIDS Relief (PEPFAR) Small Grants Program.

For many of the staff and supporters of the Center, the opening of Hawassa was a special and nostalgic moment. As the children rushed into their new home and explored every nook and cranny of the space, it became clear that a small amount of funding can change lives.

Originally, the Hawassa Children?s Center could only house some 70 orphans and vulnerable children. But after receiving a PEPFAR small grant in 2008, the Hawassa Children?s Center, located in southern Ethiopia, was able to enlarge the dormitory. Now open, the new construction has increased the intake capacity of the center by 100 children.

The inauguration of the new dormitory was attended by the PEPFAR Ethiopia team, representatives from the town, and more than 40 children who will be living in the new center.

During the inauguration of the new dormitory representatives from the town administration and the PEPFAR Ethiopia office emphasized the need to focus on sustainability of projects and the importance of integrating the children into the community.

Recently, the HIV/AIDS Twinning Center and partners at the Universidade Cat?lica de Mo?ambique (UCM) and the University of Pittsburgh in Pennsylvania celebrated the opening of a new HIV/AIDS clinic and training center in Mozambique.

Renovated with support from the U.S. President?s Emergency Plan for AIDS Relief (PEPFAR), St. Luke?s Health Center officially opened its doors on June 17, 2009.

This center works to expand accessibility of high quality primary care and HIV/AIDS services to people in the Sofala Province.

Speaking at the event, Dr. Peter Millard of UCM?s Faculty of Medicine said, ?We have partnered with the Ministry of Health to create a vital service for the local community, as well as a critical opportunity for current and future healthcare workers in Mozambique to learn important clinical skills. St. Luke?s will deliver HIV treatment in a primary care setting, which will help reduce stigma, improve accessibility, and provide ?one stop shopping? for many patients who would otherwise face long waits at the central hospital.?

While the clinic site was undergoing lengthy renovations, partners focused on faculty and curriculum development through an extensive series of professional exchanges and trainings conducted in both Mozambique and the United States.

St. Luke?s will ?serve as a center of excellence, teaching current and future healthcare workers the planned care model, a cutting edge medical practice used to care for patients with chronic diseases such as HIV, tuberculosis, hypertension, and diabetes,? said Dr. Millard.

With U.S. Government support, the University of Pittsburgh sought donations of medical equipment and supplies, arranging for two 40-foot containers of materials valued at nearly $85,000 to be shipped to Beira in November 2008.

For the UCM partners, the twinning partnership ? and the donated equipment and supplies ? have translated into improved capacity to meet the underserved needs of people in their community, both now and in the future, as more clinicians and allied caregivers are trained.

?The support we are getting from the American people, the Twinning Center, and our partners in Pittsburgh is greatly enhancing our capacity to deliver quality health services,? said UCM Vice Chancellor Fr. P. Francisco Ponsi. ?The clinic is an excellent contribution to Mozambique?s health system. Not only will it help us to assist people in the neighboring community, it will also serve as a training ground and enable us to launch an internship program for graduate-level medical students.?