Turning the Tide: Increasing Access to HIV Prevention and Care for Men Who Have Sex with Men in Ghana
Kim Green, Deputy Country Director for Ghana, FHI 360
Today, June 27, is National HIV Testing Day in the United States. It is an observance that is now recognized in many countries around the globe. Why set aside a special day for something that should be a routine part of medical care for people at risk of getting HIV? Because ending the stigma of HIV and creating multiple opportunities for testing is an urgent need in our effort to create an AIDS-free generation.
In the late 1980s, many of my friends had died of AIDS or were very sick. The decision to get an HIV test was not an easy one. But in 1986, I went for an HIV test at Whitman-Walker Clinic in Washington, DC, because it was important for me to know my HIV status. This was at a time when there were few treatment options, and the testing process involved a long and scary wait for your results. In 1995, I worked with my colleagues at the National Association of People with AIDS (NAPWA) and we created National HIV Testing Day. This effort was designed to help reduce the stigma of HIV testing and to normalize it as a component of regular health screening. At that time, there was a lot of fear about testing. Because there were few treatments, many thought it unnecessary. People who were known to be HIV positive were subjected to being fired from their jobs or becoming victims of violence. At NAPWA, we believed it was important to confront this situation by encouraging people to “Take the Test, Take Control.” We also believed that the more of us who stood up, the less the world would be able to ignore the epidemic.
Last week, members of parliament in Zimbabwe provided the type of leadership needed in the United States and worldwide to end the stigma of HIV testing. Over 47 legislators, and 60 of their staff, underwent voluntary counseling and public testing for HIV in an effort to encourage other citizens to follow suit. As a result, Blessing Chebundo, chairman of the Zimbabwe Parliamentarians Against AIDS, told SW Radio Africa that, “181 people went through the doors for testing, and 23 men underwent circumcision (proven to reduce the risk of HIV infection).”
Today, there are dozens of treatments available to keep people with HIV healthy. There is excitement also about the progress we are making in biomedical prevention interventions such as circumcision, PrEP (pre-exposure prophylaxis) and treatment as prevention. HIV testing itself is easier and quicker with results available in 20 minutes. The promise of these new opportunities begins with everyone knowing their HIV status without fear of discrimination, stigma or violence.
To learn more about National HIV Testing Day, visit the website here.
Arénia Massingue is a master trainer from the National Nurses Association in Mozambique (Associação Nacional de Enfermeiros em Moçambique [ANEMO]). Massingue, who was trained by the Food and Nutrition Technical Assistance (FANTA) project on home-based nutrition care for people living with HIV (PLHIV), explains how what she learned helped her work: “We can now see a change in behavior among our beneficiaries. Before health activists started educating them about nutrition, there was a common belief that eating well was eating purchased goods. For example, many believed that the best fruit juice was the one they bought from the store, even though they had oranges in their garden. Now they know that the oranges in their garden can produce a juice that is not only cheaper, but also more nutritious.”
Since being trained by FANTA, ANEMO master trainers trained 55 community-based organization (CBO) trainers. To date, the CBO trainers have trained 440 heath activists, home-based health care workers who provide counseling to PLHIV. PLHIV are counseled on the importance of using locally available foods in a balanced diet, management of HIV-related symptoms through diet, and potential drug-food interactions. Health activists also provide cooking demonstrations using recipes they learned during the training to help PLHIV meet their increased energy needs and eat a balanced, healthy diet. ANEMO, the Ministry of Women and Social Welfare and Ministry for Health are also working in collaboration with FANTA to integrate nutrition into the government’s official training curriculum for home-based care workers.
FANTA is a project that works globally to improve the health and well-being of vulnerable groups through technical support to the U.S. Agency for International Development (USAID) and its governmental and nongovernmental partners. The project improves nutritional outcomes by strengthening policies, programs and systems for maternal and child health and nutrition, nutrition and HIV and other infectious diseases, food security and livelihood strengthening, agriculture and nutrition linkages, and emergency assistance during nutrition crises.
For more information about FANTA, email the project at fantamail[at]fhi360.org.
May 18th is HIV Vaccine Awareness Day (HVAD), an annual observance that recognizes the contributions of thousands of volunteers, community members, health professionals, scientists, and experts in the HIV/AIDS field who are committed to working together to find an HIV vaccine. This year, we acknowledge the participation of thousands of trial volunteers who have made the research possible, and we highlight recent progress that gives us hope that controlling this epidemic is within our reach.
Great strides have been made in the three decades since the U.S. Centers for Disease Control and Prevention (CDC) reported the first cases of what we know today as HIV/AIDS. What was considered a death sentence in the early 80s is now a manageable chronic condition for those living with HIV who have access to medications. However, about 30 million people globally have died as a result of HIV/AIDS, and 50,000 Americans still become infected every year. Despite the profound impact this disease continues to have in our communities, new developments in HIV prevention efforts inspire us with the hopeful expectation of an AIDS-free generation.
Recent advances in biomedical HIV prevention research have included microbicides and pre-exposure prophylaxis (PrEP). Microbicides are gels or creams that both women and men can use topically to prevent the sexual transmission of HIV. Other products, such as films, suppositories, vaginal rings or sponges, are also being developed to release the active ingredients in the body over time. The microbicides that have proven to be partially effective to date contain an anti-HIV drug known as Tenofovir. PrEP is an approach that involves the use of oral anti-HIV drugs taken by uninfected individuals to prevent HIV infection if exposed to the virus. One drug, known as Truvada, has been shown to be effective in some populations. Consequently, on May 10, an advisory committee recommended that the U.S. Food and Drug Administration approve the use of Truvada as part of PrEP to prevent sexually transmitted HIV-1 infection. While both of these prevention strategies have varying degrees of protection against HIV, adding a safe, effective and durable vaccine to the combination of available prevention tools remains our best hope to ending the pandemic.
Scientists believe that it will take more than one approach to control the spread of HIV in the world. PrEP, microbicides and HIV vaccines, along with other proven prevention methods such as the regular use of condoms, are essential components of a comprehensive approach to global HIV prevention efforts. But, the success of the research in all these areas greatly depends on community participation and involvement as well as establishing trusting relationships within the communities most affected by HIV.
Collaboration among scientists, community leaders, and advocacy groups is essential for the fight against HIV/AIDS. In January 2012, the Be The Generation Bridge (BTG Bridge) program was funded by the U.S. National Institute of Allergy and Infectious Diseases to help increase awareness and understanding of biomedical HIV prevention research, including HIV vaccines. To learn more about this research and view community profile videos, visit www.youtube.com/bethegeneration.
A great international exchange program goes beyond sharing knowledge and ideas. It empowers participants to become agents of change in their own communities. Through Felix Masi’s participation in the International Visitor Leadership Program (IVLP), he received leadership and media training from US Government officials and prominent youth and non-profit leaders. This training motivated him to document the story of a community’s personal response to the global AIDS epidemic.
Felix, a Kenyan-born American, used the ideas he gained through IVLP, funded by the U.S. Department of State, to share the story of a challenge he witnessed growing up in Kenya. In rural Western Kenya, many children lose their parents to AIDS, and grandmothers often assume the burden and care for the orphaned children. His documentary, “A Grandmother’s Tribe,” tells the story of resilience and sacrifice in the face of a lost generation.
Further leveraging the skills honed during his exchange program, Felix founded Voiceless Children to help teach Kenyan caregivers life skills that promote self-sufficiency. To date, Voiceless Children has helped provide education and shelter for over 40 families in Western Kenya and Kibera, Kenya’s poorest slum. We are proud of program alumni like Felix, leaders who use these exchange programs to develop entrepreneurial and leadership skills that benefit not only themselves but also their communities.
Please join us on Thursday, May 10th at 5:30pm in FHI 360’s Globe Theater for a screening of “A Grandmother’s Tribe,” followed by a panel discussion featuring Felix and other distinguished speakers. A special viewing of a follow-on video that tracks the progress of the grandmothers will also be shown. Please RSVP here.
Homepage banner image from Borderless Productions.
“The Stories Behind the Statistics” is a series put together for the Bill & Melinda Gates Foundation‘s blog “Impatient Optimists” by the Interagency Youth Working Group (IYWG). The IYWG, housed here at FHI 360, provides technical leadership to improve the reproductive and sexual health of young people. The following posts were originally posted on “Impatient Optimists” and are reposted here with permission. All photos courtesy of the Gates Foundation.
I lead a support group for mothers ages 12-19, in Kenya. Most of the mothers I work with are out-of-school youth; many live on the streets, work in the informal economy, or are orphaned. As a part of our support program, we provide weekly peer-to-peer sessions focusing on uptake of antenatal care...
Read MoreGreetings to all! I recently had the opportunity to work with colleagues from FHI 360 and the National Tuberculosis Program (NTP) and National AIDS Program (NAP) in Indonesia. FHI 360 is a collaborating partner for USAID-sponsored work in Indonesia under the project called TB CARE I. We work with the Dutch organization KNCV, the World Health Organization and others to focus on integrating tuberculosis (TB) and HIV/AIDS activities and to improve access to TB care and treatment within prisons across that large and complex country.
Why are we at FHI 360 so focused on TB-HIV/AIDS integration? For a number of years, we have been working with governments to build stronger HIV/AIDS programs around the globe. What we and others have learned is that the number-one killer of people living with HIV/AIDS is TB. There is a very close, causal link between TB and HIV/AIDS. HIV/AIDS makes it many times more likely that a person will get sick with or die from TB. In addition, TB makes the HIV/AIDS virus replicate even more quickly, leading to further immune suppression and AIDS-related illness and death. Recent published research has shown that life-saving interventions include rapid initiation of TB treatment after diagnosis and rapid initiation of antiretroviral therapy (ART) after TB treatment gets started. Furthermore, isoniazid preventive treatment (IPT) can save lives by keeping people with HIV/AIDS from getting TB. An even more powerful approach for individuals already infected with the HIV virus is to get them started on ART before their immune systems become too weak.
In addition to my key objective of reviewing our TB-HIV/AIDS activities and the prison program, I served as a plenary speaker at the Indonesia Infectious Diseases Update Symposium in Malang, Indonesia. I also provided lectures and on-site consultation for members of the NTP, NAP and FHI 360 staff, focusing on multi-drug resistant TB, TB-HIV/AIDS and IPT. Our discussions showed how challenging it is to implement good programs with limited resources.
Other TB-related issues are also critical to solve. These include improving universal access to high-quality TB diagnosis and treatment, preventing spread of disease from one person to the next — especially within hospitals and clinics — and identifying and preventing disease among young children, who are at high risk for severe TB. USAID-TB CARE I provides funding to FHI 360 to work on these and related issues in Cambodia, Indonesia, Mozambique, Nigeria and Zambia.
In keeping with the theme for World TB Day 2012, “STOP TB in My Lifetime,” I want to see the epidemic of TB-HIV/AIDS become a distant memory. I am happy to report that my colleagues in Indonesia are working hard to make this come true.
World TB Day is Saturday, March 24, 2012. For more information, please visit the Stop TB Partnership’s World TB Day site.
This month, Degrees is sharing stories from participants in SMARTgirl, an FHI 360-led program aimed at preventing and mitigating the impact of HIV among entertainment workers living in Cambodia. The program provides peer education and social support, and improves access to HIV and reproductive health services. SMARTgirl treats entertainment workers respectfully and celebrates their positive qualities. SMARTgirl is funded by the United States Agency for International Development (USAID).
Twenty-three-year-old Somany is a transgender entertainment worker who has HIV. Social stigma from the community and ostracism from her family leave Somany with a deep sense of loneliness and isolation. Speaking candidly to a SMARTgirl support group, she related how every day feels like a...
Read MoreSopheap was born male but, at age 10, realized she identified as a girl. Because Sopheap’s parents feared other people’s responses, she wore boys’ clothing until age 17 “because I had to go to school and my parents didn’t like me wearing girls’ clothes.” Since then, Sopheap’s parents have...
Read MoreSineng, 21, works in a beer hall in Phnom Penh, where her job is to serve and entertain men. Sometimes she sells sex to make extra money. In the last month, she was diagnosed with HIV. Sineng fears how the virus will affect her health, her relationships and her job. Afraid and timid, she stood...
Read MoreTwenty-six-year-old Nguyen's1 husband is a shoemaker, but his income of approximately 40 U.S. dollars a month is not enough to support them and their two children. To help make ends meet — including paying the monthly rent of 30 dollars on their one-room home — Nguyen supplements the household...
Read MoreIn observance of World AIDS Day on December 1st, we will be sharing personal perspectives on how HIV has impacted our lives over the last 30 years and where we will be in the future. Check back each day until World AIDS Day for posts and videos from our staff.
The rapid scale up of highly active antiretroviral therapy (HAART) for HIV infection has been a global health success. On World AIDS Day (December 1, 2011), UNAIDSestimates we currently have 6.6 million HIV-infected people on antiretroviral agents (ARV), a number that was inconceivable less than...
Read MoreDuring the past few years, the world has made remarkable progress toward defeating the HIV epidemic. According to reports from the Joint United Nations Programme on HIV/AIDS (UNAIDS), new HIV infections have dropped 21 percent since 1997 and deaths from AIDS-related illnesses have decreased by 21...
Read MoreLeading up to World AIDS Day, there have been rallying calls to scale up HIV prevention and treatment services around the world. When it comes to treatment as prevention, there is little doubt that the HIV Prevention Trials Network (HPTN) 052 study has played an important role in furthering our...
Read MorePeter Lamptey, President of Public Health Programs at FHI 360, discusses the link between HIV and non-communicable diseases (NCDs) and why FHI 360 is investing in developing platforms to help manage the burden of NCDs.
Read MoreContraceptive technology has come a long way, but there is still much more work that needs to be done to increase women’s access to safe and effective contraceptive choices.
Since Margaret Sanger overturned anti-contraceptive legislation in 1936, making it legal for doctors to provide diaphragms and spermicides to women, researchers have been working to develop improved contraceptive methods. Oral contraceptives were introduced to the public in the 1960s and paved the way for future innovation. Today, contraceptive hormones are delivered in a variety of ways, including through implants, long-acting injections, patches and vaginal rings.
Yet there is still a gap in contraceptive technology that FHI 360 is working to fill – an effective, safe, easy-to-use, and low-cost vaginal contraceptive.
FHI 360 has developed a new vaginal insert, made of soft, non-woven textile materials that can contain different types of vaginal gels. What makes this insert innovative is that it virtually eliminates leakage of the vaginal gel, a critical issue for both effectiveness and acceptability. The insert is packaged as a single-use, ready-to-use product, pre-moistened with medicated gel. Depending upon the type of gel, the device could be used to prevent pregnancy or HIV or to treat vaginal infections.
Currently, the only over-the-counter vaginal contraceptives that are available are detergent-based spermicides containing nonoxynol-9 or similar agents. Detergent-based spermicides are irritating to vaginal tissues and with frequent use can cause ulcerations that could increase the risk of HIV infection.
The insert could be used with new non-irritating spermicides such as BufferGel® (developed by researchers at Johns Hopkins University) or with a ferrous gluconate formulation (developed by researchers at Cornell University). So far, the Hopkins and Cornell researchers have used other delivery methods, including diaphragms and vaginal rings, for their formulations. The FHI 360 insert could also be used to deliver microbicide gels, considered to be one of the most promising interventions to emerge over the past decade to prevent HIV infection in women.
Results of a pivotal study, presented on September 17 at the Reproductive Health 2011 conference, showed that the combination of BufferGel and the new SILCS® diaphragm—a one-size-fits-all device—was as effective as a diaphragm with nonoxynol-9 gel. This is a double dose of innovation—a new, non-irritating spermicidal gel and a new one-size-fits-all diaphragm—and it’s great news for women.
In 2009, we conducted a Phase I study to assess the acceptability of the FHI 360 insert among women and their male partners in Durban, South Africa, using the device saturated with 10 mL of an FDA-approved vaginal lubricant. We recruited 40 women, who first inserted and removed the device at the clinic and then at home. For home use, we asked women to discuss the product with their male partner and—if their partner agreed—to wear it during intercourse.
Participants found the insert easy to place in the vagina and easy to remove with minimal to non-existent leakage. Most men (34) agreed to have intercourse with the device in place. Participants reported that the insert was comfortable during intercourse. Most women said they would be willing to use the insert for contraception or preventing sexually transmitted infections, including HIV, and most men said they would approve of their female partners using it if it became commercially available.
Once again, we have the potential to advance women’s health in the U.S. and around the world. This is what innovation is all about – improving lives.