Key achievements and prospective issues
LAC concentrates only 2.3%of the total worldwide HIV/AIDS burden, landing in fourth place after Sub-Saharan Africa, South Asia, and East Asia and the Pacific. From 2000 to 2013, LAC had the second-highest decreasing rate on HIV/AIDS burden worldwide (42 %). At the end of 2015, roughly 1.6m people were living with HIV in a region with more than 500m people (discounting USA and Canada). The same year, Cuba became the first country in the world to receive validation from WHO for eliminating mother-to-child transmission of HIV and syphilis, with another five LAC countries close to achieving the same goal; this was one important step towards having an AIDS-free generation worldwide.
The early introduction of universal access to treatment initiated by Brazil and Argentina, massive social mobilization, new legal regulations, and efforts to control vertical transmission, stigma and discrimination converted the region in a leader in combating the HIV/AIDS epidemic.
HIV program expenditure in LAC, annually is around three billion USD. While substantial, it is under 1% of LAC’s total health expenditure. In the context of less external financing support in future and the need to improve efficiencies, LAC decided to undertake a series of 12 studies within eight countries.
An experience from Belarus on how allocative efficiency analysis changed HIV budgets
Belarus’ HIV response is faced with the need to provide treatment to a larger number of people living with HIV than ever before and to simultaneously continue scaling up prevention. How to do this in a context of limited resources, poses a major challenge for any planner. Most recent HIV estimates from Belarus illustrate the rapidly growing challenge. UNAIDS estimated that the number of PLHIV in Belarus increased from 5,600 in the year 2000 to 35,000 in 2015. New HIV infections increased from 1,700 per year in 2000 to 2,600 in 2010 and then doubled again to reach 5,300 in 2015.
Sergio Carmona and Tendesayi Kufa-Chakezha are guest blog contributers from South African National Department of Health: National Health Laboratory Services and South African National Department of Health: National Institute of Communicable Diseases, respectively.
South Africa has the largest HIV treatment program in the world with over 3 million people currently on antiretrovirals. Every year, millions of VL and CD4 count tests are carried out to check treatment eligibility for new HIV cases (CD4 count) and treatment success in those on antiretroviral therapy (ART). A VL test monitors viral suppression, the goal of ART given to a HIV-infected person. The CD4 count checks whether the patient suffers from immune deficiency due to low CD4 counts and tracks recovery of the immune system during ART. In 2014, close to half of all VL tests carried out in lower-middle income countries were done in South Africa. In addition, large numbers of CD4 cell counts have been done routinely to predict patients’ risks for opportunistic infections and provide preventive therapy where indicated. While VL and CD4 testing are essential to monitor individual ART patients, the data is also useful in tracking the impact and performance of the ART program as a whole.
One woman is victimized by violence every 15 seconds in Brazil, with a total of 23% of all Brazilian women experiencing violence in their lifetime. There are many notable consequences affecting victims of gender-based violence, yet many health consequences of violence have not been widely addressed in Brazil. This leads to the question:
Brazil has 730,000 people living with HIV, the largest number in Latin America and the Caribbean. Brazil is also one of 15 countries that account for 75% of the number of people living with HIV worldwide. Although the HIV epidemic in Brazil is classified as stable at the national level, incidence is increasing in various geographic regions and among sub-groups of women.
Rates of violence against women (VAW) are particularly high in the Southeastern and Southern regions of Brazil. These regions also have the highest HIV prevalence, accounting for 56% and 20% of all the people living with HIV in Brazil, respectively. Violence and HIV in Brazil are clearly linked, with 98% of women living with HIV in Brazil reporting a lifetime history of violence and 79% reporting violence prior to an HIV diagnosis.
Despite these statistics, there is limited research in Brazil examining VAW in relation to HIV. Accordingly, a bi-national collaboration of researchers from the University of California, San Diego, University of Campinas, São Paulo and the University of Rio Grande do Sul, Porto Alegre developed an innovative study to investigate these intersecting epidemics.
The focus of the study is in the regions of Brazil with the highest rates of VAW and highest prevalence of HIV: São Paulo in the Southeastern region and Porto Alegre in the Southern region.
The aims of the research were to describe the contextual factors of violence victimization among women in Brazil and to examine the association with HIV infection.
The study merged two population-based studies with identical sampling methodologies conducted in the São Paulo and Porto Alegre, Brazil. Women ages 18-49 years were sampled from public health centers, including 2,000 women from São Paulo and 1,326 from Porto Alegre. These women were administered surveys that gathered extensive data on violence victimization and social-ecological factors on access to preventative health services.
Kofi Annan, the former Secretary-General of the United Nations, observed that knowledge is power and information is liberating. Indeed, the collection, analysis and dissemination of data and information should not be seen only as an instrument of scientific inquiry but more importantly, as a critical tool for guiding the formulation and implementation of policies to address complex problems in society.
The recent Durban 2016 International AIDS Conference celebrates the success of AIDS treatment in reducing illness and death. The pall of despair and wasting death that hung over the Durban 2000 International AIDS Conference has truly been lifted. In KwaZulu-Natal, where the conference was held, AIDS treatment has increased community life expectancy by a full 11 years, reversing decades of decline -- life expectancy in KwaZulu-Natal is higher today than before the HIV epidemic. This is indubitably one of the great successes of global health.
Dear Colleagues and Friends,
I wanted to take this opportunity to wish you a Happy New Year, and reflect on several notable events from 2015 - a year of remarkable progress in global health, and remarkable expansion for the World Bank Group's health, nutrition and population portfolio, which grew to more than $10 billion.
The World Bank Group’s new Gender Equality Strategy for 2016-2023, launched last week, addresses gender inclusion not just as a goal in and of itself, but one critical to development effectiveness.
The days that I spent on the Big Cities project taught me how to handle different people from all walks of life, who were diagnosed HIV positive. Working there, I learned that HIV/AIDS does not choose its victims, whether rich or poor.
One of them happened to be my close friend. I really didn’t know how to tell him about his HIV status. It was hard… really hard to be his HIV counselor. It was difficult putting myself in his shoes, for example, when this diagnosis must’ve felt like the end of the world for him. But I knew that I had to be strong for my friend.
I wondered how I could help him if I wasn’t strong myself, so I promised him that I would do my best to support him, which was similar to what I do for other people living with HIV.