INNOVATIONS IN GLOBAL PUBLIC HEALTH POLICY
March 10, 2009
(POSTED by Shivani Sud:)
Texts used to tackle South Africa HIV crisis by Stephanie Busari
http://www.cnn.com/2008/HEALTH/12/01/hiv.text.messages/index.html?iref=newssearch
Commentary:
In a country where HIV/AIDS and cell phones are abundant, Pop!Tech and HIV charities and other firms have come together to harvest the power of mobile phones to help encourage HIV testing. As part of project Masiluleke one million free text messages will be sent everyday for twelve months to cell phone holders in South Africa to increase HIV awareness and testing rates. The program uses a "Please Call Me" service that allows someone to send a free message to a friend asking them to call them. There is usually a 120 character space along with the message that is usually taken up by advertising which helps to pay for the service. The message being sent out by the project reads "Frequently sick, tired, losing weight and scared that you might be HIV positive? Please call the AIDS Helpline 0800012322." The program administrators believe that thus far the program has been a great success since calls to the help line have already increased from 1,300 to 3,600 calls per day. The messages are sent in both English, as well as local languages such as Zulu.
This appears to be the largest ever use of cell phones for a health awareness campaign. The program organizers were creative and practical in their use of cell phones since most people in South Africa own cell phones and use them as their primary means for obtaining information. The program appears to be making progress considering the 200% increase in calls to the helpline, but given estimates suggesting that 6 million people in South Africa are likely infected with HIV, 3600 calls a day is still a very low number. According to the article people who call can receive HIV counseling and referrals to local clinics. Even though the program seems like an innovative application of technology, it seems to bring little new information to the table. The stigmas surrounding HIV will still be present no matter how many times you text someone telling them call the HIV hotline. The extent of government denial and lack of access to affordable treatment, are large barriers, which a cell phone texting program might not be able to overcome. Ultimately, whether or not the campaign has an impact on HIV prevalence and testing will not depend on how many people receive the messages or even how many people call back, but the ability of the program to change the stigma surrounding HIV, influence HIV testing rates and increase the precautions taken to prevent HIV infection.
Combating Malaria in Benin: The Mosquito Net Distribution Campaign by Sylvie Nenonene
http://web.worldbank.org/WBSITE/EXTERNAL/COUNTRIES/AFRICAEXT/0,,contentMDK:21743876~menuPK:258657~pagePK:2865106~piPK:2865128~theSitePK:258644,00.html
Commentary
In order to support one of its primary goals of developing human capital, the World Bank is tackling Malaria through a thirty-one million US dollar grant to the Malaria Control Booster Project. The program, which distributes insecticide covered nets to families started on March 16th of 2007 and by April 2008 geographic coverage was at nearly one-hundred percent in the African country of Benin. With the World Bank funding, the Malaria Control Booster Project purchased 1.4 million nets, and through other funds has managed to distribute 1.8 million mosquito nets throughout Benin. In addition to nets, the group is distributing vitamin A and albendazole whose coverage rate stands at 98.2 and 88.3 percent respectively. Malaria has had an enormous impact on Benin, and 34% of patients in clinics come seeking Malaria treatment. The government of Benin has decided to take action and has adopted a national policy to combat malaria through insecticide covered net distribution and intermittent preventative treatment for pregnant women. Through these initiatives, the government hopes to curb Malaria related deaths by fifty percent by 2010 in comparison to 2001 numbers.
It is quite fascinating that just distributing insecticide covered nets has the ability to dramatically decrease malaria related morbidity. The government has been very responsible in not only establishing goals related to deceasing the impact of malaria, but actually taking action to achieve them. Many countries use the excuse of not having adequate funding as a reason to avoid initiatives to fight disease. Benin however, recognized its lack of funding and approached the World Bank as well as other groups for funding. The government went a step further in its realization that children are most vulnerable to Malaria and is distributing vitamin A and albendazole to children under five which reflects the governments understanding of the importance of the next generation. The cooperation needed to execute such a project is immense. The government first had to admit that there was a pressing issue, pursue an avenue for obtaining funding, and decide how to spend the funds and how to distribute the materials. It is impressive that there was so much cooperation at so many different levels. In this sense Benin serves as a true role model for other African nations in their approach to an infectious disease. Even though the government has been very active in their distribution program, they have not found a long term solution to the malaria issue. As long as there are bodies of stagnant water, sanitation issues and mosquitoes, malaria will continue to exist and it is not possible to perpetually distribute nets. The government needs to find a way to address the sources of malaria and not only control its impact on humans. The goal of halving numbers of malaria deaths sounds ambitious, but it seems like the government might be taking a publicity short cut by using 2001 numbers which may have been unusually high as a reference point as opposed to 2007 which the distribution program was initiated. Hopefully the distribution campaign will lower malaria deaths to a manageable level and then the government of Benin will take measures to impact the sources of malaria.
AIDS and the Scientific Governance of Medicine in South Africa (AIDS Denialism)
April 9, 2008
(posted by Rashad Badr)
On April 7th, 2008, Nicoli Nattrass, a professor of economics at the University of Cape Town and an outspoken political activist in South Africa, spoke on "AIDS and the Scientific Governance of Medicine in South Africa (AIDS Denialism)". Nattrass began the talk with the proclamation that South Africa has the capability of doing more in its fight against the AIDS epidemic and many of the efforts to do so have been unjustly hindered by political sources. She highlighted the role of key South African political leaders, such as President Mbeki and Health Minister Manto Tshabala-Msimang, in perpetuating what has now become known as AIDS denialism while also examining some of the social and political complexities that have lead to health care failures, such as treatment anarchy and the failure to effectively distribute anti-retroviral medications. Nattrass concluded with proclaiming that the battle today in South Africa is primarily over the need to lower drug costs, improve human resources for health, and effectively distribute scientifically tested medicines.
Nattrass is the author of Mortal Combat: AIDS Denialism and the Struggle for Antiretrovirals in South Africa
Global policies, local realities: HIV testing and AIDS drugs in rural Malawi
February 12, 2008
On February 11, 2008, Kim Dionne a doctoral candidate in political science (UCLA) and Research Affiliate of the Malawi Research Group, spoke on, "Global policies, local realities: HIV testing and AIDS drugs in rural Malawi." She highlighted her ongoing research as well as that of the larger research group (led by Susan Watkins at Penn), which among other things, has investigated the attitudes and preferences of rural Malawians with respect to testing and treatment. Dionne highlighted some surprising findings, including the fact that many rural residents in this high prevalence country are not expressing strong demands for increased AIDS-related goods, opting instead for other types of goods. By contrast, foreign aid has been heavily focused on HIV/AIDS.
For more information, go to: http://www.malawi.pop.upenn.edu/
SGAC World AIDS Week
February 9, 2008
Starting on Nov. 30 and going on to the following week, the Student Global AIDS Campaign held World AIDS Week to raise awareness on AIDS issues on campus, as well as raise money for Partners in Health Rwanda.
The following are events we held:
Friday Nov. 30 - Benefit Concert in conjunction with Theatre Intime
Monday Dec. 3 - Wearing of "Orphan" T-shirts around campus
Tuesday Dec. 4 - Keynote Address by Senator Bill Frist
Wednesday Dec. 5 - Address by Sandra Bandah, an AIDS activist in Zambia
Wednesday Dec. 5 - Screening of the film Rent
Thursday Dec. 6 - AIDS Vigil, with a few words from Professor Jeff Nunokawa
Furthermore, there were many other signs of our presence on campus, including ribbons on lamp-posts, flags on the Frist Lawn, a banner over McCosh Walk, and many other posters.
Various SGAC members will post on each event in more detail, but the week was a tremendous success, one of the best that SGAC has ever had.
AIDS and Genocide in Rwanda
December 9, 2007
On November 9th, 2007 the Student Global AIDS Campaign (SGAC) - Princeton provided a free screening of the critically acclaimed film "Hotel Rwanda". Few in attendance initially understood the connection between the genocide in Rwanda and AIDS. The opinions of the crowd reflect a larger trend in public opinion that largely distinguishes AIDS and genocide causes with distinct groups focused on fighting each cause independently. SGAC-Princeton aimed to raise awareness about the unfortunate, yet significant, link between AIDS and genocide. This is particularly the case in the Rwandan genocide, where AIDS was used as a genocidal weapon, targeting Tutsi women. Over the course of the genocide, hundreds of women were raped, many of them contracting HIV/AIDS.
The screening went to benefit the group Avega Agahozo which seeks to serve the over 25,000 women widowed by the genocide, particularly those who contracted HIV/AIDS. A study by Avega from three of the 12 provinces in Rwanda showed 66 percent of the 1,200 widows tested were HIV positive. Not only are AIDS and genocide linked, but, as Avega has shown, many of the effects of genocide complicate the AIDS problem, where most rape victims shun HIV testing. The stigma attached to being raped during the genocide has caused many women to remain silent, waiting only until their conditions worsen to receive testing. Attempting to recover from the genocide, Rwanda has paid little attention to the needs of these widows. Avega currently provides HIV/AIDS care to 773 people, including 268 individuals receiving antiretroviral therapy.
For more information about Avega, go to: http://www.avega.org.rw/English.html
Co-infection: HIV, Malaria, and beyond
October 19, 2007
On Monday October 15th, Professor Burt Singer spoke at a Princeton AIDS Initiative-sponsored event on the subject of, "Malaria and HIV Co-infection: The Scope of the Problem and Its Policy Implications." Singer, an expert in the epidemiology and policy of tropical disease, made the point that co-infection more generally is widely prevalent throughout the developing world, especially in sub-Saharan Africa. In other words, "HIV and Malaria is just piece of a larger story." Singer points out that while we have a fair bit of data on the global burden of individual diseases, we know very little about co-infections, except where, for example, there have been rigorous demographic surveillance surveys. Singer stressed that it was difficult to make firm conclusions based on such limited evidence, but at the very least, organizations such as the Global Fund for TB/AIDS and Malaria ought to encourage more proposals to study and address co-infection. Given the extent to which people in the developing world may suffer with 5 or more parasites alongside another significant infectious disease, the time has come to pay more serious attention to the implications of co-infection.
Singer also highlighted many of the potentially adverse health consequences of large-scale economic development projects, and pointed to the need for greater surveillance and mitigation efforts. Here is a link to a related article co-authored by Singer: http://www.pnas.org/cgi/content/abstract/104/41/16038
Democracy and AIDS in Africa
September 27, 2007
This week, the Princeton AIDS Initiative hosted Per Strand, a researcher from the University of Cape Town (UCT). Per is affiliated with the Center for Social Science Research (CSSR) and The Democracy in Africa Research Unit (DARU). NB: No South African organization exists without a proper acronym.
In two presentations, Per discussed some of the work being done at UCT and elsewhere on the relationship between AIDS and various political processes. For example, might the extreme incdence of HIV and AIDS be undermining democratic institutions owing to the ill health of voters and/or representatives? Several hypotheses have been put forward, but so far there is no conclusive evidence that this is happening. Other related work includes studies of public opinion. For exampe, the Afrobarometer project -- one of Per's colleagues, Bob Mattes, helps direct this -- has shown that by and large, African citizens have prioritized jobs/employment and crime over AIDS policies, which may help to explain the degree to which such policies have not figured prominently in political campaigns.
Links to the activities at CSSR and DARU can be found at: http://www.cssr.uct.ac.za/
The Afrobarometer survey may be found at http://www.afrobarometer.org/
Family Planning Prevents HIV
September 21, 2007
Family planning is one of the most cost-effective ways to prevent new cases of HIV and is the most effective strategy to reduce mother-to-child transmission of HIV. Mathematical modeling shows that, for the same expenditure, increasing contraceptive use averts more HIV-positive births than the traditional PMTCT strategy (ARV prophylaxis).
Yesterday the INFO Project of the Johns Hopkins Bloomberg School of Public Health announced an important new issue of Population Reports on family planning for women with HIV by Catherine Richey and Vidya Setty.
The authors note that current contraceptive use prevents over one million HIV-positive births worldwide each year and that increased contraceptive use could have a larger impact. They write:
In sub-Saharan Africa, where rates of HIV prevalence among women are the world's highest, meeting the family planning needs of women with HIV has great potential to reduce further the number of HIV-positive births. It is estimated that one-fourth of all births in sub-Saharan Africa are unintended. Assuming that 25% of HIV-positive births are also unintended, meeting the family planning needs of all women with HIV in sub-Saharan Africa has the potential to avert 120,000 HIV-positive births each year.
The report also points out that the great majority of women with HIV are unaware that they are infected. This means that access to family planning for all women should be part of HIV prevention programming.
Bureaucratic Shenanigans in South Africa
August 17, 2007
Last week, SA president Thabo Mbeki fired the Deputy Health Minister -- who had been hailed for making real progress on AIDS policy, particularly while the Minister was sidelined with her own health problems. This has caused quite a stir -- re-enforcing the notion that Mbeki continues to be an "AIDS denialist," not willing to take aggressive action on the problem. I have pasted below from the Aegis website a clip from an AP story describing Stephen Lewis' anger towards Mbeki.
SOUTH AFRICA: Former UN Envoy Accuses South Africa's President of Failing to Stop 'AIDS Apocalypse'
Associated Press (08.15.07) - Thursday, August 16, 2007
Clare Nullis
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In an opinion piece written for South African newspapers, former UN Special Envoy for AIDS in Africa Stephen Lewis has warned that Thabo Mbeki "will always be known as the president who presided over the AIDS apocalypse."
"It is said that 900 men, women, and children die every day in South Africa of AIDS-related illnesses," Lewis wrote. "Other than South Africa, every government in high-prevalence countries is moving heaven and earth to keep its people alive."
The latest row between AIDS activists and the government stemmed from Mbeki's firing last week of Deputy Health Minister Nozizwe Madlala-Routledge. While her boss, Manto Tshabalala-Msimang, was sidelined by a liver transplant, Madlala-Routledge revived the nation's fight against AIDS, particularly by helping to craft a five-year strategic plan. Mbeki said he sacked Madlala-Routledge because she was not a team player.
Activists have long accused Mbeki of being in denial about South Africa's AIDS epidemic, and Tshabalala-Msimang has been the object of international ridicule for attempting to discredit antiretrovirals while promoting instead a special diet for AIDS patients. Lewis' editorial blasted "the demented absurdity of beetroots," one of the foods endorsed by Tshabalala-Msimang, and said Mbeki is "running against the universal tide of public dismay."
Lewis is calling for the international community to press the government to implement the five-year plan, whose goals include halving the number of new HIV infections and getting treatment to more than 80 percent of adults with AIDS by 2011.
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Recent PAI Panel on AIDS Treatment and Human Rights
May 7, 2007
On Friday April 27th, the Princeton AIDS Initiative hosted the final seminar of a year-long colloquium on AIDS Treatment. The panel considered the question of whether access to AIDS Treatment ought to be considered a human right. Helen Epstein of the Center for Health and Well-being offered some introductory remarks, and Sofia Gruskin of Harvard University and Joseph Amon of Human Rights Watch presented their arguments and analysis. Joe has forwarded an overview of his presentation and some links, which is pasted below:
Is HIV Treatment a Human Right? (from Joseph Amon)
HIV treatment is clearly a human right and just as governments are obligated to progressively realize the right to health, they must plan and make progress on providing access to HIV treatment. From a strategic standpoint, however, Human Rights Watch has not always chosen to focus on the right to health as the most urgent and immediate obstacle to ensuring access to HIV treatment. Instead, we look at the broad range of rights abuses that are occurring in a country and how these abuses are affecting those most vulnerable to HIV and most marginalized by society. For example, in Zimbabwe, Human Rights Watch looked at the effects of forced evictions and a crackdown on the informal sector of the economy by the Zimbabwean government on the HIV epidemic - both in terms of both preventing new infections and in terms of access to HIV treatment for the 1.6 million Zimbabweans living with HIV. In our report we wrote about the right to life, the right to seek, receive and impart information of all kinds, the right to nondiscrimination and equal protection of the law, and the right to be protected from violence. We wrote about the right to work and the need to enforce protections of women from property grabbing in divorce and inheritance; and, certainly about the right to the progressive realization of health. Our report underscored the indivisibility of all of these rights in the realization of wider access to HIV treatment, and it held the government to account for its failures to uphold these rights. It also called upon the international community to do more to address both the AIDS and the human rights abuses being perpetuated in Zimbabwe. Beyond the question of "Is HIV treatment a right?" we advocate for health policies and interventions that are based upon rights -non-discrimination, equitable access, and removing human rights abuses which represent barriers to care - not only for their importance as rights, but also for their importance as sound public health practice. Ultimately, we feel that government accountability is critical to ensure that all rights are realized, including the right to health. Around the world much of the calls for accountability on AIDS have not come from traditional human rights organizations but from AIDS activists who have demanded participation in government programs and decision-making. Our job at Human Rights Watch has also been to stand up for these activists as they face persecution and abuse.
Additional info:
HRW HIV/AIDS program webpage: http://hrw.org/hivaids
HRW HIV/AIDS Zimbabwe report: http://hrw.org/reports/2006/zimbabwe0706/
Blog on AIDS and human rights: http://www.eliminateaids.blogspot.com/