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.

What are the keys to family planning success in Africa?

This was originally published on the Global Health TV website on June 24, 2014.
 
In the last 20 years, Ethiopia has emerged as a family planning powerhouse. In Studies in Family Planning, I reported that, from 1990 to 2011, modern contraceptive use increased ninefold, from 2.9% to 27.3%, and the total fertility rate (the average number of children born to a woman in her lifetime) dropped from 7.0 to 4.8.

Now Ethiopia’s reputation has been further burnished by the results of a report released May 27^th by Performance Monitoring and Accountability 2020 (PMA2020) that show an increase in the use of modern contraception from 27.3% in 2011 to 33.3% in 2014 and a drop in the fertility rate from 4.8% to 4.4%.

Four Central Determinants of Success

This prompts the question: What are the factors that lead to family planning success? And what are the factors that stall such progress? Our article in Studies in Family Planning identified four determinants of success in Ethiopia. I suspect that many, if not all of these, ring true elsewhere in sub-Saharan Africa:

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.

Condom flavors like strawberry and caipirinha key to social marketing success in Brazil

A print ad for DKT's new caipirinha condom brand.

This was originally published on the Huffington Post on June 10, 2014.

SÃO PAULO, Brazil — “DKT do Brasil,” the social marketing juggernaut of South America, started in 1991 with one variant of Prudence condoms (now called Prudence Clássico). Over 23 years, DKT has grown that product line into 40 variants, with its latest offering featuring the flavor and scent of caipirinha, the iconic Brazilian cocktail made from cachaça, lime and sugar.

Over that same time period, its condom sales increased from 30,840 in 1992 to 124 million in 2013. This is considerably more than the combined total sales of every other condom social marketing project in all Latin America — South America, Central America and the Caribbean — according to DKT contraceptive social marketing statistics.

And yet DKT do Brasil does not consider itself a commercial enterprise, but a social enterprise. All of its products make money, and yet all are within the contraceptive affordability index, which dictates that the cost of contraception should be less than 1% of a family’s annual income. In fact, its cheapest condom, Prudence Clássico, is only 0.22% and even its most expensive brand is less than 0.5%.

How has DKT do Brasil been able to become the largest social marketing operation in Latin America, and one of the largest condom distributors in Brazil, while remaining true to it mission of “improving lives by encouraging family planning, sexually-transmitted disease prevention, pleasure and well-being; offering products that are accessible, diverse, innovative and high quality in Brazil and South America”?

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.

Social enterprise for health, Brazilian style

With the leaders of Saúde Criança at their headquarters in Rio de Janeiro.

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

RIO DE JANEIRO, Brazil — One is poised to become the condom market leader in Brazil, with 40 variants in its Prudence condom line. Its newest offering features the flavor and scent of caipirinha, the iconic Brazilian cocktail made from cachaça, lime and sugar. DKT believes it prevented over 9,000 HIV infections in 2013.

Another rescues the poorest and unhealthiest children from the urban slums of Rio de Janeiro, Sâo Paulo and other cities, and nurses them – and their families – back to health.  Since its creation, an estimated 50,000 people have benefitted from its work.

They are very different global health organizations, with very different operating models, but both call themselves social enterprises, Brazilian style, and both were created in 1991.

Tuberculosis finally catching up to 21st century

This was originally published on Global Health TV on March 24, 2014.

Tuberculosis (TB) treatment, which had been lost in a time warp for a century, seems to be finally joining the 21^st century.

Until recently, there were no new TB drugs on the market in half a century, little progress in the treatment of multidrug-resistant (MDR) and extensively drug-resistant (XDR) forms of TB and virtually nothing new on pediatric TB, according to David Greeley, the president and CEO of Accordia Global Health Foundation, who previously worked for the TB Alliance. The current vaccine, developed more than a century ago, is largely ineffective, he said. TB diagnostics were ancient, too, as is TB itself, which has been around since 4,000 B.C. Current treatment was cheap and sometimes effective but took a long time and misses a lot of people  (like children, and MDR and XDR patients).

Which is why the Stop TB Partnership has made those missing people the theme of this year’s World TB Day on March 24: “Reach the 3 Million.” That’s the number of TB patients the World Health Organization (WHO) estimates are “missed” by public health systems out of the 8.6 million who fall ill of TB each year.  Many of those 3 million live in the world’s poorest, most vulnerable communities and include groups such as migrants, miners, drug users and sex workers. Over 95% of TB deaths occur in low- and middle-income countries. India and China are the countries with the most TB patients.