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

On World AIDS Day 2009, the U.S. Government underscored its commitment to the fight against global AIDS.

"On World AIDS Day, let us renew our commitment to ensuring that those infected and affected by HIV - the woman on treatment who is supporting her family, the child who dropped out of school to care for sick parents, the doctors and nurses without adequate resources - that all those who have joined together to fight this pandemic will someday live in a world where HIV/AIDS can be prevented and treated as a disease of the past," said Secretary of State Hillary Rodham Clinton at the White House World AIDS Day event.

Ambassador Eric Goosby, U.S. Global AIDS Coordinator, also affirmed the U.S. Government's commitment to halting the global AIDS pandemic and emphasized its continued support for the U.S. President's Emergency Plan for AIDS Relief (PEPFAR).

"It is important to acknowledge the work of President George Bush ...and a bipartisan Congress in creating and continuing to support PEPFAR. The American people can truly be proud of the work that is taking place, and of the dedicated people who are doing this work.

Yet it is equally true that the global AIDS emergency is far from over. Countries still struggle with vast unmet needs. There are vast unmet needs in our own country. We need to work harder - and smarter - than ever before, laying a foundation that countries can build on for the long term," said Ambassador Goosby.

While both acknowledged more needs to done if the AIDS epidemic is to be defeated, Secretary Clinton also recognized the many successes achieved in the fight against HIV/AIDS thus far.

"We have made progress, but we face an unending pandemic, one that spares no one, that unfortunately, disproportionately affects the most vulnerable, and which is the defining health challenge of our times. And we have to address it through a series of broad and crosscutting global partnerships and a whole-of-government approach. And that is exactly what we are attempting to do.

"We know the ravages and complexities of HIV/ AIDS here in our own country, and we know, many of us, what it looks like around the world. But we can take some heart in the progress that has been made over the last two decades. Access to antiretroviral treatment in low- and middle-income countries has risen tenfold in the last five years. New HIV infections have fallen by 17 percent over the last eight years. And much of that progress has been due to the concerted efforts of the United States Government and our partners," said Secretary Clinton.

PEPFAR also announced its newest results on World AIDS Day 2009. As of September 30, 2009, PEPFAR directly supported life-saving antiretroviral treatment for over 2.4 million men, women and children through its partnerships with more than 30 countries. In addition, PEPFAR partnerships directly supported care for nearly 11 million people affected by HIV/AIDS, including 3.6 million orphans and vulnerable children. And in fiscal year 2009, PEPFAR directly supported prevention of mother-to-child transmission programs that allowed nearly 100,000 babies of HIV-positive mothers to be born HIV-free, adding to the nearly 240,000 babies born without HIV due to PEPFAR support during fiscal years 2004-2008.

Launched on World AIDS Day, the Five-Year Strategy of the U.S. President's Emergency Plan for AIDS Relief (PEPFAR) outlines the high-level direction of the program for its next phase. This strategy reflects lessons learned in the first five years of the program, expands existing commitments around service delivery, and places a heightened emphasis on sustainability.

The annexes - "PEPFAR and Prevention, Care and Treatment"; "PEPFAR and the Global Context of HIV"; and "PEPFAR's Contributions to the Global Health Initiative" - provide additional detail on the high-level direction of PEPFAR outlined in the Five-Year Strategy.

At the launch of the Strategy, Ambassador Goosby highlighted the areas PEPFAR will focus on moving forward.

First, the program will transition from an emergency response to promotion of sustainable country programs.

"PEPFAR has already started this with its Partnership Framework activity, which is a five-year strategic plan developed in collaboration with our partner governments. But we need to do more, especially around supporting the creation of mid-level government capacity to oversee, manage and eventually finance these programs. It is a good start," said Goosby.

The strategy also describes how PEPFAR will work to strengthen partner government capacity to lead the response to this epidemic and other health demands.

"If we are to sustain the gains we've had and have made against this epidemic, PEPFAR must work in closer collaboration with country governments to support and mount a truly global response to the shared global burden of disease," he said.

In addition, the documents discuss PEPFAR's efforts to expand prevention, care, and treatment in both concentrated and generalized epidemics; integrate and coordinate HIV/AIDS programs with broader global health and development programs to maximize impact on health systems; and invest in operations research to evaluate impact, improve service delivery and maximize outcomes.

"Today, the situation is markedly different. PEPFAR has brought hope to millions of people across the world with its treatment and care programs. ...But unmet needs are still the dominant feature of this program. ...I look forward to working closely with partner countries, other donors, and PEPFAR staff in the field to implement the concepts of this strategy," said Ambassador Goosby.

During his November 2009 trip to Ethiopia, Ambassador Eric Goosby, U.S. Global AIDS Coordinator, participated in a number of roundtable discussions on HIV/ AIDS programs with government officials, local service providers, and representatives from universities and professional associations.

The first of these discussions took place at Addis Ababa University and brought together the Deans from Jimma, Gondar and Hawassa Medical Schools, as well as representatives from the Ethiopian Ministry of Health, professional associations and students. During the discussion, Ambassador Goosby stressed that a well trained and motivated health work force is key to strengthening service delivery. Ambitious government targets for training more health workers, especially physicians and midwives, require training institutions to be staffed with sufficient faculty and adequate facilities to support learning.

U.S.-Ethiopian academic partnerships are particularly important as incentives to in-country teaching faculty. With support from the U.S. President's Emergency Plan for AIDS Relief (PEPFAR), one innovative approach uses computer technology to simultaneously transmit lectures to Addis Ababa medical faculty and regional medical schools.

Roundtable participants also discussed the Ethiopians Government's plan to greatly increase the number of physicians to be trained. A new problem-oriented curriculum is being finalized, but keeping staff at public health facilities remains challenging. To address this issue, the Ethiopian Ministry of Health and professional associations are working together to develop incentives to promote improved staff retention and quality.

While in Ethiopia, Ambassador Goosby also met with local service providers from associations of people living with HIV/AIDS, faith-based organizations, public and private health facilities, local non-governmental organizations, caregivers of orphans and vulnerable children, and mothers living with HIV/AIDS.

His discussion with local service providers focused on the unique nature of front-line service provision and the challenges associated with ensuring quality and comprehensive HIV prevention, care, and treatment services. In a meeting with service providers across the continuum of prevention, care, and treatment, Ambassador Goosby listened to the stories of mothers and people living with HIV/AIDS, as well as nurses, counselors, and community organizers. Topics discussed included improving access to services, community care and support programs, and the impact of stigma and discrimination.

In a separate session, Ambassador Goosby also participated in discussions with heads of Regional Health Bureaus, HIV/AIDS Prevention Offices and key focal persons in other sectors. During this conversation, Ambassador Goosby learned about the regional capacity to deliver a comprehensive response to HIV/AIDS in Ethiopia and how the U.S. Government can better support this in future years.

Ambassador Goosby's November 2009 trip to Ethiopia was his first since assuming the role of U.S. Global AIDS Coordinator in June 2009.

On December 1, 2008, the U.S. President's Emergency Plan for AIDS Relief (PEPFAR) launched a World AIDS Day Poster Contest reflecting the theme "Celebrate Life." PEPFAR invited young people between the ages of 5 and 20 from around the world to submit posters displaying their original artwork.

The winning posters, featuring artwork from five continents, were debuted in a poster show launched around World AIDS Day 2009.

On December 2, 2009, the U.S. Embassy in Guyana honored two young, local artists whose artwork was featured in this poster show.

At the ceremony, which was attended by competition entrants and students from surrounding schools, contest winners Mariea Harrinarine and Athaliah Lambert received prizes for their posters and certificates from PEPFAR recognizing their achievement.

Colorful and vibrant, Harrinarine and Lambert's pieces were chosen for inclusion in the PEPFAR Poster Show and were exhibited at World AIDS Day events in the United States and around the world.

During the celebration, U.S. Embassy Chargé d'Affaires Karen Williams reaffirmed the U.S. Government commitment to its partners in the fight against global AIDS.

In Guyana, the "Celebrate Life" poster competition involved the collaboration of PEPFAR, the Peace Corps, the Guyanese Ministry of Education, the Volunteer Youth Corps and the Guyanese National AIDS Programme Secretariat.

To view the complete PEPFAR poster show, please visit: www.flickr.com/photos/pepfar/.

The United States Department of Defense (DoD) recognizes the global threat HIV/AIDS poses to U.S. national security - as well as that of the rest of the world - and is combating it through the efforts of the DoD HIV/AIDS Prevention Program (DHAPP) and the U.S. Military HIV Research Program (MHRP).

DHAPP was established in 2001 to combat HIV/AIDS in Africa and India to work with foreign militaries to decrease the impact of the disease. The program oversees the contributions to the U.S. President's Emergency Plan for AIDS Relief (PEPFAR) of a range of DoD organizations, which fall under the various regional military commands, as well as specialized DoD institutions whose primary mission falls within the continental United States.

It now has implemented programs in 75 nations across Europe, Africa, Asia and Latin America.

To provide for the unique needs of the military population, DoD hires partner country nationals to facilitate interactions between the DHAPP technical experts located at its headquarters at the Naval Health Research Center and the partner country military HIV/ AIDS program leaders. These country nationals provide invaluable support because they are most familiar with the cultural and political backdrop of their individual nations and therefore provide a unique perspective and dedication to the programs.

One such individual is Antonio Langa, a Mozambican national working for DoD. He is the main point of contact for DoD and PEPFAR activities directed to the Mozambican military - coordinating frequently with the Mozambican minister of defense, the chief of the army and the director of national military health. His tasks range from discussing annual plans with the Mozambican military, to overseeing the training of military doctors and nurses, to implementing military prevalence and behavioral studies.

"I would describe my role as one of an actor in an action/thriller movie. I'm the beginning and end of whatever happens in benefit of the Mozambican military. If I don't fight for money to fund activities, then the program does not exist," Langa says.

One program that Langa has worked tirelessly to support is the Mozambique Armed Forces Local Radio Station Broadcast. The radio program informs soldiers about all aspects related to HIV/AIDS, such as prevention and risk reduction (male circumcision, condom use, partner reduction), diagnosis (counseling and testing), care (opportunistic infections, tuberculosis, sexually transmitted diseases), and treatment (prevention of mother-to-child transmission, prevention with positives, anti-retroviral therapy). It includes live discussions with doctors and other relevant people with a telephone number that listeners can call to ask questions on the air.

"The idea for the radio program was inspired by the movie 'Good Morning Vietnam,' and I just used the same approach and converted it to focus on health issues, with an emphasis on HIV/AIDS," Langa says. According to Langa, the project presented logistical challenges, but because the Mozambican military took ownership of the station, it became a success.

"The Mozambican military accepted the challenge and provided the space to install the station. They also identified young soldiers to be trained and operate the radio equipment. DoD brought in a team to train the Mozambicans on operating a military radio station - from gathering and processing information, to broadcasting, to monitoring and evaluation," Langa says. "We found great acceptance of the project since it is operated by the Mozambican military themselves."

The initial idea was to use a closed circuit radio - a DJ station and speakers installed in selected areas of the military base - but ultimately the project ended up as an FM radio station covering a much wider area around the military base, therefore reaching more people. Because the radio program also broadcasts to non-military areas, it covers other public health issues as well.

"The surrounding community benefits from the radio program because they are able to discuss health issues of interest to them," Langa says.

Both programs receive support from PEPFAR, as well funding from the Army and other U.S. federal agencies such as the National Institutes of Health.

Additional information about DoD-supported efforts to combat global AIDS is available online at: www.health.mil/Content/docs/MHS_Profiles_AIDS.pdf.