In Brazil, condoms become popular by emphasizing fun, not responsibility

DKT promoted its Prudence brand of condoms in the São Paulo Carnival of 2019, as they do every year.

This was originally published by Knowedge4Health Blog on March 11, 2019.

SÃO PAULO, Brazil — In 1991, a non-profit social marketing organization set out to make condoms accessible and affordable in Brazil at a time when condoms were hard to find and expensive and the number of Brazilians infected with HIV was climbing. In the process, DKT Brazil made its brand Prudence the number one condom in the very competitive Brazilian market, and also helped enhance contraceptive security. 

The result is that condoms have become normalized in Brazil – more used and less stigmatized – and that has helped limit the spread of HIV.

In 1990, the World Bank estimated that Brazil would have 1.2 million people living with HIV by 2000. However, that never happened: By 2000, there were fewer than 500,000 infections. After peaking in 1996, according to UNAIDS, AIDS-related deaths have remained fairly stable. Brazil is now considered an HIV success story. Condoms – distributed both by the public and private sectors – played an important role in that success.

Prudencehas become the most popular condom in Brazil by taking a very different approach to the positioning and marketing. While most commercial condom distributors marketed their products for responsibility and protection, DKT eroticized its condom messaging, celebrated sexuality and used humorous vernacular, with no medical jargon. Its advertising was daring and provocative: The PrudenceYouTube page demonstrates that.

10 lessons we've learned from AIDS that we can apply to chronic diseases

An assistant at the Etoug-Ebe Baptist Hospital, a subsidiary of the Cameroon Baptist Convention Health Services, takes a blood sample of a patient participating in the Novartis Access program to fight non-communicable disease. Photo: Anne Mireille Nzouanekeu

This was originally published on the Huffington Post on October 30, 2017.

Communicable diseases like HIV/AIDS and malaria have taken a terrible toll on Kenya and other African countries over the last 20 years. In 2010, an estimated 51,000 Kenyans died from AIDS but that number has declined steadily, to 36,000 in 2016. Kenya is now considered an HIV success story. The same is true in many other countries.

Now there is a new epidemic of non-communicable diseases (NCDs) that is rising just as the world is starting to get a handle on communicable diseases, according to the Institute for Health Metrics and Evaluation. The Institute reports that the largest contributors to the loss of healthy life are now high blood pressure, smoking, high blood sugar and excess body weight.

But Dr. Samuel Mwenda, who knows a thing or two about both epidemics, believes there are lessons we have learned in the fight against communicable diseases that can now be applied to NCDs. Mwenda is general secretary and CEO of the Christian Health Association of Kenya (CHAK), a network of Protestant health facilities in Kenya. CHAK now supports 46,000 people living with HIV with antiretroviral therapy, representing about 9 percent of the total number of patients nationally.

In 2015, CHAK turned its attention to NCDs: With the support of Novartis Access, it began offering a portfolio of 15 products to treat cardiovascular disease, diabetes, respiratory illness and breast cancer at a price to governments, NGOs and other institutional customers not to exceed $1.00 per treatment per month. Since then, Novartis Access has also started working in Cameroon, Ethiopia, Pakistan, Rwanda and Uganda.

Dramatic global health improvements save lives but new threats emerge

This was originally published on the Global Health TV on September 26, 2017.

Over the last decade, we’ve made great progress against diseases and health conditions that can kill people, especially children under 5, but because of political and budget challenges, we risk backsliding on those gains. And we’re facing a tsunami from health issues that do not always kills us – namely, obesity, conflict and mental illness – but cause poor health.

Those are my take-aways from two major reports that came out this month, one tracking how we are doing against the Sustainability Development Goals, particularly in global health, and the other a scientific study focused solely on global health.

“Goalkeepers: The Stories Behind the Data 2017,” a report from the Bill & Melinda Gates Foundation, was aimed at last week’s United Nations General Assembly. To draw attention to the report, the Gateses held a high-profile event featuring former President Barack Obama. The report touts the many global health advances that have been made but also cautions about the risks of complacency.

Initiatives to expand access to medicine on the rise, but need better evaluation

In Nairobi, Kenya, parents receive prescription medicines for their children as part of a free medical camp operated by Slums Information Development & Resources Centers. Photo: George Onyango, Courtesy of Photoshare

This was originally published on Global Health TV on August 31, 2018.

In the 1990s and 2000s, AIDS activists and other global health advocates started pressuring pharmaceutical companies to share their largesse with low- and middle-income countries (LMICs) by supplying critical medicines for free or at subsidized prices, especially for HIV/AIDS. The pressure was successful, and led to a series of access-to-medicine (AtM) initiatives.

The international community increasingly recognizes that the pharmaceutical industry must play a leading role in improving access to medicines. And apparently pharma companies themselves also acknowledge this responsibility, according to a study published in Health Affairs by a team of researchers at Boston University Department of Global Health. That study found that the number of these initiatives grew from 17 in 2000 to 102 in 2015. The researchers called this “clear evidence” that pharmaceutical companies had responded to calls to increase their commitment to improving access to medicines.

Budget debates in US, UK could augur poorly for global health funding

This was originally published in Global Health TV on July 25, 2017.

Global health financing has not been in such jeopardy since the large investments in it started in 1991 – the year in which global health funding started an upward trajectory that moved higher in all but three years.

In particular, the rise of Donald Trump of the United States and Theresa May of the United Kingdom —the leaders of the two largest donor nations — have raised concerns about the prospects for development assistance broadly, and global health specifically.

In 2016, development assistance for health (DAH) reached $37.6 billion, eking out a miniscule 0.1% increase from 2015 that followed a pattern of little growth since 2010 (DAH grew 11.4% annually from 2000 to 2010 but only 1.8% since 2010), according to “Financing Global Health 2016,” published by the Institute for Health Metrics and Evaluation in April. DAH peaked at $38 billion in 2013, dropped to $36 billion in 2014 and has recovered slightly in the two subsequent years. This infographic provides a snapshot.

The U.S. and the U.K. have been the two top contributors to DAH but both countries have political environments that have called into question their future commitments to foreign aid and global health.

New test to detect HIV in babies boosts hope of meeting UN targets

This was originally published on Global Health TV on October 25, 2016.

When Saquina, a 38-year-old single mother living in Nacala Porto, Mozambique, learned she was HIV positive while pregnant, she thought her life was over. Instead, she decided to accept her HIV status and follow the advice of the nurse who counseled her.

She did not miss any visits to the health center. She took the pills that helped prevent transmission of the virus to her unborn child. She participated in support groups with other HIV-positive mothers. When her son Frenchou was born, she gave him medication every day and breastfed him exclusively for six months.

When he was two years old, Frenchou was tested for HIV and found negative — another of many recent successes in the prevention of mother-to-child transmission (PMTCT), according to the Elizabeth Glaser Pediatric AIDS Foundation.

Between 2009 and 2015, there was a 60% decline in new HIV infections in children in the 21 priority countries, according to a UNAIDS report released in June. Seven of those countries reduced infections by more than 70%. A total of 1.2 million new infections among children were averted in these countries.

But if you thought thought that all is now well with PMTCT, and that we can move on to other HIV challenges, you would be mistaken. While a 60% drop is certainly encouraging, it is significantly below the 90% target set by the World Health Organization (WHO). UNAIDS has set a goal of eliminating all new HIV infections among children by 2020 while ensuring that 1.6 million children have access to HIV treatment by 2018.

Kenya starts to shift focus to chronic diseases while not relenting in HIV fight

A patient at a rural health camp in Mwae County, Kenya has his blood pressure checked as part of a full physical exam. If he needs hypertension treatment, he will get it as part of the cost of the camp. Photo: Bedad Mwangi

This was originally published on Global Health TV on June 28, 2016.

For some time, huge disparities between global health spending and the global disease burden have raised concerns that this funding was not being allocated based on the evidence. That is, money was not always going where the disease burden was greatest.

The Institute for Health Metrics and Evaluation (IHME) has pointed out that the disparities are most extreme in HIV/AIDS on the high end and non-communicable diseases (NCDs) on the low end.

As the toll from communicable diseases like AIDS and malaria decline and people live long enough to get NCDs, we need to invest more in fighting NCDs (also called “chronic diseases”) and reduce these glaring disparities between global health spending and disease burden. Countries like Botswana, Eritrea, Kenya Malawi, Mozambique, Rwanda, South Africa, Swaziland, Tanzania, Uganda, Zambia and Zambia — all countries that increased their treatment coverage by more than 25% between 2010 and 2015, according to UNAIDS — now have to pivot to NCDs without taking their eyes off of HIV.

Kenya is an excellent case in point.

In West Africa, progress on family planning but millions not treated for HIV

Women gather for the launch of the national family planning campaign in a low-income neighborhood of Bamako, Mali in April.

This was originally published on Global Health TV on April 26, 2016.

BAMAKO, Mali — Last year, there were several reports of how West Africa, after decades of seriously lagging behind the rest of the world (and Africa) in family planning, was finally starting to embrace it. IntraHealth International covered this topic extensively on its Vital blog, and I wrote about my own views of family planning in Mali here at Global Health TV.

Senegal, in particular, emerged as a family planning leader in West Africa and provided hope for the rest of the region. The three main reasons for Senegal’s success were strong political will, better coordination and collaboration and innovative approaches, according to Babacar Gueye, IntraHealth country director in Senegal.

New programs here in Mali, like Keneya Jemu Kan (USAID Communications et Promotion de la Santé, in the Bambara language), are making a major push to increase health indicators beyond the anemic progress of the past three decades. For example, the percentage of married women using any modern method of family planning in Mali has only increased from 1.3% in 1987 to 9.9% in 2013, and Keneya Jemu Kan is working to bend that rate upwards. (Full disclosure: I work as a consultant for Keneya Jemu Kan).

But a disturbing new report from Médecins Sans Frontières (MSF), or Doctors Without Borders, claims that similar progress is not being made in HIV/AIDS. On the contrary, MSF claims that millions of people in West and Central Africa are being left out of the global HIV response despite globally agreed goals to curb HIV by 2020, and is calling on the international community to develop and implement an urgent plan to scale up antiretroviral treatment for countries where critical medicines reach fewer than one-third of the population in need.

Amid a flurry of high-tech approaches, some find merit in low-tech techniques

DKT street theater provides family planning information in Bihar.

This was originally published on Humanosphere blog on March 7, 2016.

Because of the meteoric rise of the internet and cell phones in many developing countries, many global health programs have been rushing to embrace these technologies as efficient ways of reaching large numbers of people with information on such issues as family planning, HIV prevention and maternal and child health.

This is happening in countries like India, Tanzania, South Africa, and Ethiopia, where technologies like the internet, mobile phones, social media and geographic positioning systems are bringing health delivery into the 21^st century.

But some programs are eschewing high tech and sticking with low tech as the best way to bring vital health information to their low-income consumers, at least for now.

The social marketing legacy of Phil Harvey

This originally appeared on the Huffington Post on December 15, 2015.

From 1992 to 2001, I did some of the most important – and fun – work of my life: I managed social marketing programs for the nonprofit PSI in Zambia, Bangladesh and Paraguay. Social marketing is a technique that uses the tools of social marketing to achieve a social outcome – in PSI’s case, that outcome is improved health. The programs I worked on were HIV prevention, family planning and child health but social marketing can also be applied to other disciplines as well.

I owe that singular experience to Phil Harvey, who founded PSI in 1970 to promote family planning through the social marketing mechanism. In 1989, he founded DKT International, another social marketing organization more tightly focused on reproductive health mainly in very large countries (in order to have cost-effective impact at greater scale). Harvey has also served, and continues to serve, for many years on the board of directors of Marie Stopes International, another organization that uses social marketing.

Phil Harvey is introduced as “a visionary, pioneer and titan in the world of social marketing” in this new video interview. Harvey describes his early work in India, the roots of social marketing, his creation of two social marketing organizations, his legal battle with the State of New York over reproductive health issues (that went all the way to the U.S. Supreme Court) and the impact of social marketing.

Global health funding: Huge increases since 2000, but also huge disparities

This was originally published on Global Health TV on July 27, 2015.

As the end of the era of the Millennium Development Goals (MDGs) (2000-2015) draws near, we who work in global health can look back with some satisfaction at the $228 billion that was allocated to address the three health-related MDGs during that time.

Although spending grew rapidly in the first ten years, it was stagnant between 2010 and 2014, and actually decreased by 1.6% between 2013 and 2014. Global health funding in 2014 amounted to $36 billion in 2014 (of which $1 billion was for Ebola).

That information comes from Financing Global Health 2014: Shifts in Funding as the MDG Era Closes, the annual report of global health funding published last month by the Institute for Health Metrics and Evaluation (IHME).

And two weeks ago, the Kaiser Family Foundation and UNAIDS issued a report that showed that although there was only a slight increase in funding for HIV in low- and middle-income countries in 2014 (less than 2%), seven of 14 donor countries actually decreased funding despite the recent gains made against the epidemic.

New development goal falls short of protecting those most at risk of HIV

This ISHTAR wellness center in Nairobi works to ensure that gay men have access to non-discriminatory HIV and sexual health services. Credit: Corrie Wingate for the International HIV/AIDS Alliance.

This blog was originally published by The Huffington Post on May 8, 2015.

Dominique, 26, realized he was gay in his early adolescence and now sells sex to other men to survive and to support his relatives in Kisii, in western Kenya. He goes regularly to a drop-in center outside Nairobi run by the Kenya AIDS NGO Consortium (KANCO) where he gets a holistic package of HIV and sexual and reproductive health services.  As a result, he is HIV-negative.

Dominique is a good example of why we need to support people most vulnerable to HIV. Yet the language currently proposed in the Sustainable Development Goals (SDGs) falls short of prioritizing the most marginalized and vulnerable groups (the SDGs are the new development goals replacing the Millennium Development goals which expire later this year).

Goal 3 of the SDGs is to “ensure healthy lives and promote well-being for all ages.” Target 3.8 under this goal commits to Universal Health Coverage (UHC). Unfortunately, the UHC target and indicators do not meet the specific needs of the most marginalized, stigmatized and underserved people in the world — like men who have sex with men (who are 19 times more likely to contract HIV than the general population) and transgender women (who are up to 49 times more likely to acquire HIV than all adults of reproductive age).

Reaching adolescents with the right kind of HIV and sexual health services

Pacifique, who was born HIV-positive, has finally found a safe space.

This was originally published on the ONE Blog on Dec. 4, 2014.

Pacifique is a 20-year-old student living in Bujumbura, Burundi, who found out he was born HIV-positive when he was 10 years old. He had been taking anti-retroviral medication for a year without knowing what it was for.

“My mum refused to disclose my status to me,” recalled Pacifique. “She told me I had a heart problem but that I would get better. I was frightened when I found out. I thought I would never get married. It hurt me to think I would never have children.”

Pacifique is hardly alone. There were an estimated 2.1 million adolescents living with HIV in 2012, with more than 80% of them living in sub-Saharan Africa. Many don’t know their HIV status. HIV is now the number one cause of adolescent mortality in Africa and the second biggest in the world (UNAIDS defines adolescents as ages 10-19). Between 2005 and 2012, HIV-related deaths among adolescents increased by 50%.

Young people most affected by HIV finally gain a seat at the table

Link Up aims to improve the sexual and reproductive health and rights of more than one million young people living with and most affected by HIV in Bangladesh, Burundi, Ethiopia, Myanmar and Uganda. Here's a group of young people above in Ethiopia. Credit: International HIV/AIDS Alliance

This blog was originally published by the Huffington Post on Dec. 1, 2014.

Earlier this year, young Ugandans saw an opportunity to influence the HIV response in their country by coming together to determine their priorities for the New Funding Model of the Global Fund to Fight AIDS, Tuberculosis and Malaria, a major funder of HIV programs.

The meeting included young members of “key populations,” including people living with HIV, people who use drug, sex workers, transgender persons, men who have sex with men, fisher folk and truckers, and was facilitated by young women living with HIV. These young people are rarely consulted in a meaningful way in the design and implementation of HIV/AIDS programs, even programs targeting them, in Uganda and globally.

These priorities were eventually shared in the form of a Young Key Populations Priorities Charter. The priorities identified provided a template for action that, if accepted by the Global Fund, could lead to more effective programming for young people, increased engagement by young people in policy development and national planning processes and, ultimately, genuine change on the ground.

This is one example of how young people, and particularly those living with HIV and from these key populations, are starting to engage meaningfully in the design and implementation of HIV/AIDS programs meant to help them, something long past due.

Ebola makes the definitive case for health workers and strong health systems

This blog was originally published by Global Health TV on Nov. 25, 2014.

Since I first wrote about Ebola here at Global Health TV two months ago, the number of Ebola deaths has more than doubled, to 5,459, and the number infected has reached 15,351, according to the World Health Organization. Ebola has caused countless angst and affliction, mostly in West Africa but also in Spain and the U.S.

But there is one good thing that Ebola has done: It has made the case for strengthening health systems and frontline health workers more effectively than we in global health have been able to do. It has shown that weaknesses in health systems in poorer countries can affect people in richer countries. It has made that case not only to the global health community, but to the entire world.

“Weaknesses in West Africa’s health systems do not affect just West Africa – they affect us all,” said Pape Gaye, president and CEO of IntraHealth International, in testimony to the U.S. Senate Appropriations Committee on Nov. 12. “Ebola, HIV and other viruses and infectious diseases do not respect borders. Globally, our countries’ health systems are interconnected, creating one global interdependent health system. Today, that system is woefully precarious.”

We will not banish AIDS until we banish stigma

Eugene comes to a drop-in center for men who have sex with men.

This originally appeared on the ONE Campaign Blog on July 23, 2014.

Earlier this year, I met Eugene and Dominique at a drop-in center for men who have sex with men (MSM) outside Nairobi, Kenya.

Eugene, 23, comes to the center regularly to get condoms, lubricants and HIV counseling and testing, and has brought other gay men to the center. So far, he is HIV-negative.

Dominique, 26, also frequents the center. He was treated for a sexually-transmitted infection, and gets tested there every month. He, too, is HIV-negative.

In Kenya, most gay men are very much in the closet, due to the strong stigma against them. Many of these men would not have access to health services if not for the handful of drop-in centers in Nairobi, Kisumu and other urban centers for the simple reasons that most health facilities are not gay-friendly. Quite the contrary. Thus, most MSM have no access to gay-friendly services.

AIDS-free generation will not be achieved without more investment in harm reduction

Abubakar, an injecting drug user since 1989, receives a safe injecting kit in Nairobi, in a project supported by the International HIV/AIDS Alliance.

This was originally published on the Huffington Post on July 21, 2014.

NAIROBI, Kenya -- In 2010, the United Nations announced that an AIDS-free generation was achievable if we focused on the most disadvantaged communities.

Almost four years later, three leading harm reduction organizations are telling us we are not paying enough attention to one of those communities -- people who inject drugs (PWID) -- and that "an AIDS-free generation will not be possible" if the rate and pace of investment in harm reduction continues.

Harm reduction is a range of public health policies designed to reduce the harmful consequences associated with, in this case, injecting drug use.

To coincide with the 20th International AIDS Conference in Melbourne, Australia, Harm Reduction International, the International Drug Policy Consortium and the International HIV/AIDS Alliance are publishing a report that says that due to changing donor policies, HIV prevention services for PWID are not being prioritized and this failure to invest will bring an exponential rise in HIV transmission which will impose much higher costs on governments and donors.

Global health needs more strange bedfellows, unorthodox partnerships

Puppets walking into the audience at the SwitchPoint conference in Saxapahaw, North Carolina.

The was originally published on the Huffington Post on July 14, 2014.

In Tanzania, the non-profit group IntraHealth International works with a cotton gin to provide circumcision services to their male employees and collaborates with local police to bring together 400 motorcycle taxi drivers to learn about road safety and HIV prevention. Both projects are funded by the U.S. Centers for Disease Control and Prevention.

The African Christian Health Associations Platform, based in Kenya, is working with Novo Nordisk and Johnson & Johnson that provide Christian health associations in several countries with technical support, training and drugs to combat diseases like diabetes, HIV and opportunistic infections.

Those are examples of an increasingly common approach to development. It used to be that a donor would sit down with the ministry of health to work out the design and implementation of a new global health initiative, with no significant input or involvement of other stakeholders. Those days, thankfully, are long gone.

Nowadays, it's widely recognized that more stakeholders need to be consulted, both in the design and the execution of an intervention. Does this make the process more messy and complicated? It sure does, but this messiness is essential to take global health to the next level.

Kenya quietly takes public health approach with HIV most at-risk groups

Chief Rose Ayere talks to a group of injecting drug users in Nairobi.

This was originally published on Global Health TV on May 27, 2014.

NAIROBI and KISUMU, Kenya — Anti-gay legislation recently signed into law in Uganda and Nigeria has alarmed organizations implementing HIV prevention in Africa, fearing that such laws will further stigmatize and marginalize at-risk populations already hard to reach with health services.

So when I traveled to Kenya this month to interview men who have sex with men (MSM), injecting drug users (IDUs), and people working in programs trying to help them supported by the International HIV/AIDS Alliance, I wondered whether I would encounter “the next Uganda” in gay rights. I did not, but what I did find surprised me.

Movers, shakers, thinkers, doers converge on former N.C. mill town

This was originally published by the Huffington Post on April 9, 2014.

One is a British mobile phone guru who has become a storyteller of "reluctant innovators," propelling some of the most exciting social innovations outside the traditional development system.

Another is an architectural wunderkind from Togo in West Africa who leads a team that recycles old plastic bags into building materials.

And a third is a San Francisco Bay Area global health tech innovator who is building a web platform to help African countries make better decisions about HIV drug procurements. He speaks English, Punjabi, Spanish and Mongolian.

The three are very different but have at least two things in common: First, they are hellbent on changing the world. Second, they are converging on the tiny former mill town of Saxapahaw, North Carolina later this month to share their distinctive world views with hundreds of other global thinkers and doers.