|11 December 2014
Sex worker in a brothel in Quito, Ecuador. (The Global Fund / Ivan Kashinsky)
Elena Reynaga found her vocation as a champion of sex worker rights in the darkest hours of Argentina’s military dictatorship in the 1970s, when thousands were abducted on city streets. As a sex worker, she was detained by the police in Buenos Aires, and subjected to a mock execution, which was terrifying. “We came into being as a movement by way of a reaction to the political repression of those years,” said Reynaga. She considers herself lucky to be alive. “There were girls who simply disappeared without trace. Nobody spoke out for them. After all, who was ever going to defend common prostitutes?”
Reynaga is not a typical activist. She learned to read when she was 48. She became an effective speaker when she founded a union for sex workers in Argentina in 1994. It encourages sex workers to set up cooperatives and to lobby for recognition. Today she is the Executive Secretary of RedTraSex, a network of sex workers in Latin America and the Caribbean that campaigns for formal recognition of sex work. The network is a Principal Recipient of a regional Global Fund grant for HIV prevention. “Sex work is not criminalized in Latin America, but it’s not allowed either. We have a legal vacuum that allows the police to target and harass sex workers,” she said.
Reynaga defends sex work and points out that she raised two children and paid for their education with her earnings. She criticizes campaigners who call for abolishing sex work, and believes that making it illegal would drive it underground and expose sex workers to even more abuse than they face now. A fully legalized sex trade, she argues, will instead bring sex workers out of the shadows and make health services more easily accessible to them, reducing incidence of sexually transmitted diseases such as HIV. “As work conditions improve for sex workers, HIV prevalence will decline,” she says with certainty.
Signs of hope and danger persist. Reynaga sees Uruguay as a model of tolerance in Latin America, where sex workers can qualify for state pensions. At the other extreme, a wave of murders in Central America, especially in Honduras and El Salvador, where gangs target sex workers. In her native Argentina, the old round-ups are in the distant past. This year, Reynaga received an outstanding achievement award from Argentina’s Senate.
In global health, where diseases constantly change, responses are changing too. One way to try to steer change in a positive direction is to build evaluation and feedback into regular work. When our new funding model was designed, it intentionally included a number of tools to collect feedback. One of the most important is the Technical Review Panel’s review form, to provide a summary of the panel’s recommendations for each individual concept note. It includes highlights of a concept note, strong elements of the proposed programs, areas of weakness and specific recommendations.
The review form is primarily intended for each Country Coordinating Mechanism. But it also serves to inform the Global Fund’s country team of possible obstacles or issues, or to point out areas where technical cooperation is needed. In addition to the forms for individual concept notes which are sent directly to an applicant, the Technical Review Panel issues reports summarizing findings. Based on the technical analysis of proposals, the panel points to specific observations and insights, general and disease-specific. One goal is to help countries improve the concept notes they will submit in the future. Another goal is to highlight broader issues across the grant portfolio. Posted online, the report is also shared with the Country Coordinating Mechanisms, the Secretariat, technical partners and anyone wishing to tap in.
In parallel, the Global Fund’s Access to Funding Department also reports on outcomes, positive trends and areas of improvement identified during concept note review, with statistics and feedback on the process and case studies on notable programs.
Surveys are an important tool for this analysis. After the submission of a concept note, members of the Country Coordinating Mechanism and others who participated in country dialogue are invited to take part in an online survey to assess their views on the quality of their country dialogue and concept note development. The responses inform the Global Fund about weaknesses and problems, so getting that information is highly appreciated. Anyone who took part in country dialogue, and can find the time for a survey, is encouraged to contribute.
One key issue this year is gender. Many countries report difficulty integrating gender issues as part of a national health plan. A recent analysis of the first 20 concept notes received by the Global Fund revealed gaps not only at the planning level but also in terms of providing resources to support programming that can shift views on gender. This tool can be useful in helping country teams to understand gender issues and how to work with respective countries to address them. It is also useful in highlighting where more information needs to be made available, and perhaps also where technical support can be useful.
Global health is facing a changing landscape full of opportunity and challenge. Today, 70 percent of the world’s poor live in middle-income countries and an increasing number of countries are transitioning from low-income to middle-income status. On disease burden, 66 percent, 76 percent and 54 percent of HIV, tuberculosis and malaria, respectively, are now in middle-income countries. Within some countries and regions, HIV and tuberculosis are concentrated in specific locations and among key populations where domestic funding is limited. And while certain countries and regions are making remarkable progress against diseases, others, particularly conflict-afflicted states, are falling behind. This changing landscape calls for a tailored Global Fund approach.
To begin this work, the Global Fund has convened a working group that brings together experts and communities from a range of backgrounds, disciplines and organizations to explore how to engage with changing country contexts and the evolving development landscape. The Development Continuum working group first met in October 2014, and is charged with establishing key facts about the changing development landscape, highlighting implications for the Global Fund partnership, and making recommendations to the Secretariat. Anders Nordström, Ambassador for Global Health in Sweden’s Ministry for Foreign Affairs, chairs the group which will report its recommendations to the Board of the Global Fund in March 2015. These recommendations are an important input into the upcoming 2015 consultations on the 2017-2021 Global Fund Strategy.
That strategy is expected to reflect a differentiated approach to health investment for countries across the development continuum. “As we understand the continuum better, we can better understand how our partnership can support countries as they progress along the continuum,” said Mark Dybul, Executive Director of the Global Fund. “If we don’t engage people from the countries in the thinking and, in fact, to set the direction, we will be overtaken by events beyond our control. From an understanding of what countries want and need, we can then explore how the Global Fund can best serve them.”
The Pacific Friends for Global Health has welcomed the Australian Government’s $50 million contribution to Gavi, the Vaccine Alliance, which will help drive down the burden of vaccine-preventable disease in the world’s poorest countries.
Today’s announcement brings Australia’s support over the 2011-2015 period to $250 million (with a $32 million contribution to the Gavi bond scheme, known as IFFIm.)
The Chair of the Pacific Friends, Wendy McCarthy AO, said the commitment would improve health outcomes in countries where it was needed most.
“Since the turn of the century, Gavi’s contribution to global public health has been a genuine game changer. Australia’s continued strong support will help this life saving work continue.
“Particularly in our region, Gavi has had an outsized impact. This is a smart decision that will pay important social dividends.”
Since 2000, Gavi has immunised almost half a billion children, approximately half of them in our region.
This has helped avert approximately six million deaths.
Between 2016 and 2020, Gavi is aiming to secure an additional $US7.5 billion to immunise a further 300 million children, saving between five and six million lives.
“Every indicator shows that vaccines are one of the best value buys for the public health dollar,” Pacific Friends executive director, Bill Bowtell said.
“Australians can be confident and proud that their Government’s support for Gavi is money extremely well spent.”
Sydney film premiere:
A compelling story of sexuality, activism and hope by renowned Swedish filmmaker.
On the eve of World AIDS Day (1 December 2014) the Pacific Friends of The Global Fund are proud to present the Sydney premiere of the compelling documentary film Transmission: The journey from AIDS to HIV.
Thirty years in the making, Transmission: The journey from AIDS to HIV tells the powerful and very human stories of those living with HIV and the activism behind society’s changing attitudes about the disease.
Blending archival footage with interviews from the present, world renowned Swedish documentary filmmaker Staffan Hildebrand lays bare the taboo issues of sex and sexuality against the backdrop of fear and misunderstanding in the 80s and 90s. He expertly contrasts this with the messages of hope and positivity delivered by the young, tech-savvy, AIDS activists of today.
Hildebrand first visited Australia in 1988 as part of a global effort to document the struggles and activism of those suffering HIV/AIDS. His unique record, known as the Face of AIDS archive, is held at the Karolinska Institutet in Sweden and spans over 900 hours of archival footage.
In Transmission: The journey from AIDS to HIV Hildebrand revisits the Australian doctors and health workers who were on the frontline of the AIDS epidemic in the 80s and featured in his archive. As a counterpoint he also retraces his steps through AIDS ravaged Cambodia, providing a fascinating insight into the inequities in treatment between our two countries.
In the end though, Hildebrand leaves us with a message of hope. He captures the unshakable spirit of the activists who have driven social change and the pride with which HIV positive people live with their diagnosis.
Transmission: The journey from AIDS to HIV was funded through the generous support of The Myer Foundation, The Lord Mayors Charitable Foundation (Melbourne), The Finkel Foundation, ACON, The Victorian AIDS Council and The Burnet Institute.
Staffan Hildebrand was awarded a prestigious Fullbright Scholarship in 1968. Inspired by changing media he bought his first video camera and by 1971 he was covering the Vietnam war for Swedish National Television News from Vietnam, Laos and Cambodia.
In 1983 he came to international prominence directing his first full length feature G, a box-office hit about youth culture, drugs and rock ‘n’ roll. Hildebrand also directed Nights of Stockholm (1987) and Someone to love (1990), both of which achieved box office success.
In 1988 Hildebrand’s first documentary on HIV/AIDS was selected as the opening film for the IV International AIDS Conference in Stockholm.
Director Staffan Hildebrand is available for interview from Sweden. Participants in the documentary including Sebastian Robinson, Nic Dorward and Abby Landy are available for interview locally.
Available online at www.queerscreen.org.au
Mobile: 0434 850 782
Blog by Dagfinn Høybråten, the Chair of the GAVI board
With its natural beauty and breath-taking scenery Lao is without a doubt one of the brightest jewels of Southeast Asia. However it is also one of the poorest nations in Asia with a weak health system and stark geographical disparities in health outcomes. Last week I was privileged to visit the country with a group of Australian parliamentarians. It was a chance to witness first hand the critical work Gavi, the Vaccine Alliance, is doing to fight preventable disease in this captivating, land-locked Southeast Asian country, and also to meet with national political leaders.
One of the institutions we visited was the Sethathiraj Hospital and Cancer Centre in the capital Vientiane. Here we learned of the scourge cervical cancer represents to local women. Medical specialists told us that the hospital treats many women with this type of cancer, but that they struggle to deal with the number of patients presenting with large, late-stage tumours.
Part of the problem is that people in remote rural areas have little or no access to diagnosis in the early stages and so need to travel a long way to the capital for medical help. To make matters worse, for most of these villagers the necessary medical treatment is prohibitively expensive.
This is part of a sad story we witness in most developing countries, where cervical cancer kills more than a quarter of a million women every year, or roughly one every two minutes. More than 85% of those who die from the disease live in the poorest parts of the world where access to screening and treatment is limited, and often non-existent. Most simply do not receive the treatment they need.
Although the trip to Lao was a stark reminder of these realities, we also witnessed how this situation is changing. Lao People’s Democratic Republic (PDR), to use its official name, now aims to protect Lao women against most cases of cervical cancer by implementing the human papillomavirus (HPV) vaccine, with the help of Gavi.
My travel companions the Australian Members of Parliament (MP) witnessed the results of this when visiting Ban Akad Primary School. As we arrived, the schoolyard was filled with young girls in school uniforms waiting in line to get their HPV vaccination as part of a demonstration HPV vaccination program currently being carried out. Prevention is better than treatment and this is never more true than the form of a simple vaccination, especially when diagnosis and treatment is, in too many cases, simply not available.
Given that the HPV vaccine was first developed at the University of Queensland, for the Australian MPs it must have been inspiring to see first hand how an Australian innovation, together with Australian investment of aid money in the Gavi partnership, was protecting lives in Laos.
Laos has a growing economy and is determined to increase its spending on health and on vaccines. But the Gavi assistance with low cost vaccines and funding to help strengthen Lao’s health systems is crucial now, to get the vaccines rolled out to those in need.
The case of HPV is an example of how the Vaccine Alliance model can help shape a market to ensure a high quality vaccine reaches the people who need it, and at an affordable price. It is also a compelling case of equity. Vaccines have generally been available in the world’s richest nations, despite a greater disease burden in developing countries. However, HPV vaccine is now being rolled out in countries where people previously had no access to this powerful public health tool. By 2020, we estimate more than 30 million girls in 40 countries will be immunised against cervical cancer.
Globally, one-in-five children born each year still do not have access to the most basic vaccines, and 1.5 million children die each year of vaccine preventable diseases.
But visiting Laos gave inspiring examples of the change that is taking place.
Gavi has supported the immunisation of almost half a billion children already, saving six million lives. In January next year, the Vaccine Alliance will ask for funding from government and other donors to help vaccinate a further 300 million people by 2020, to save a further 5-6 million lives. There can be no better investment than that.
Global Fund News Release: 23 September 2014
NEW YORK – A passionate call for low and middle income countries to increase their spending on health was launched by Kenyan President Uhuru Kenyatta at the United Nations General Assembly on Monday evening.
Hosting an event called “Domestic Financing for Health: Invest to Save,” President Kenyatta laid the groundwork for a strong partnership for increased investments in health, bringing together leaders from several African countries, the African Union, United Nations Foundation and the Global Fund to Fight AIDS, Tuberculosis and Malaria.
Ethiopian Prime Minister Hailemariam Desalegn and Rwanda Minister of Health Dr. Agnes Binagwaho joined President Kenyatta and other African leaders at the event, signalling a unity of purpose in a bid to sustain momentum against the world’s most challenging diseases.
Countries implementing health programs financed by international funders are playing a bigger role in financing health. This has led to a tremendous impact on global health. Last year during the Global Fund replenishment conference, which galvanises resources for the fight against HIV, tuberculosis and malaria, several African countries made significant commitments to increasing their investments in response to the diseases and in strengthening health systems in their countries.
In the coming years, these countries are expected to take a leading role not only in urging the world to spend more in fighting diseases but also in investing more of their own money toward saving lives of their people. Yesterday’s meeting, led by Kenya, signals an accelerated effort toward that end.
President Kenyattaurged African countries to explore ways to galvanize local resources for health, to build health systems and sustainable interventions against diseases. “We have depended on external help for health services, but we have to mobilise domestic resources to find our own solution instead of moving from one crisis to another,” President Kenyatta said.
The President’s keynote remarks led to a panel discussion that made a strong case for spending more local resources on health as a way to saving lives as well as strengthening economies.
A report published last year by the AU and UNAIDS said that from 2001 to 2011, health budgets in AU Member States increased from 9 percent to 11 percent of public expenditures. Six AU Member States – Liberia, Madagascar, Malawi, Rwanda, Togo and Zambia – have achieved a target set in Abuja in 2001 to allocate 15 percent of public expenditure to health.
President Kenyatta said Kenya is making plans to hit this target. Saying that the fruits of Africa’s economic growth would only be beneficial if proper investments were channeled toward health, the president urged African countries to invest in their own solutions to keeping their people healthy.
In a spirit of shared responsibility and global solidarity, the meeting focused on the need to pool local and global resources to garner substantial wherewithal to enable the world to achieve victory over the world’s deadliest infectious diseases – HIV, tuberculosis and malaria. The meeting also explored what leaders from low and middle income countries can do to accelerate wide-ranging and innovative investments in health.
Lawrence H. Summers, Professor and President Emeritus at Harvard University, who now chairs the Lancet Commission on Investing in Health, GlobalHealth2035.org, also spoke at the event. He argued that today we have the technology and financial means to close the health gap between poorer and richer nations, to achieve what he is calling “a grand convergence in health.”
“The grand convergence would dramatically reduce infectious, maternal and child deaths within one generation, averting 10 million deaths in 2035,” Dr. Summers said. “Governments in low and middle income countries must invest in health. Just 1 percent of their economic growth over the next two decades would fund the grand convergence. The global community must support poorer countries and spearhead the search for new technologies.”
Other panellists included Dr. Mark Dybul, Executive Director of the Global Fund, and Tumusiime Peace, the Commissioner for Rural Economy and Agriculture at the African Union.
Global Health News
Pacific Friends of the Global Fund to Fight AIDS, Tuberculosis and Malaria is a high-level advocacy organisation which seeks to mobilise regional awareness of the serious threat posed by HIV & AIDS, tuberculosis and malaria to societies and economies in the Pacific. In pursuing its goals Pacific Friends has a specific interest in highlighting the need to protect the rights of women and children in the Pacific.