24 March 2014
Shawn Clackett

TB: Reach the 3 Million

Global Fund News Release: 24 March 2014

JOHANNESBURG, South Africa – The Global Fund is accelerating efforts to support countries implementing tuberculosis programs with the aim of reaching three million people that are not diagnosed, treated or documented in the fight against the disease every year.

Three million of the nine million people that get sick with TB do not get the care they need.

Many countries around the world are now strengthening their TB strategic plans and setting new targets to drive down the numbers of deaths and cases of TB, while identifying priorities, best use of domestic resources, and funding gaps for controlling TB.

The Global Fund has a new funding model that seeks to support countries in filling those gaps, by focusing on the needs of the most vulnerable people in settings with high rates of TB. Inclusive country dialogue and investing for impact are fundamental to the new funding model, and to finding the missed three million.

To mark World TB Day, Mark Dybul, Executive Director of the Global Fund, visited South Africa with Dr. Lucica Ditiu, Executive Secretary of the Stop TB Partnership, for a ministerial meeting of South African Development Community countries. The meeting – hosted by the South African deputy president and sponsored by the World Bank, Stop TB Partnership and The Global Fund – is working to harmonize the region’s response to tuberculosis infection amongst the mining community. This partnership has a focus on reducing the burden of TB amongst a population that accounts for about 30 percent of all infections in Southern Africa.

“Our partners are driving a more targeted approach, and we support efforts to accelerate in that direction,” said Dr. Dybul. “People in countries with these vulnerable populations who make up a big percentage of the missing cases can take advantage of the flexibility and agility of the new funding model to reach more people affected by TB.”

The World Health Organization and the Stop TB Partnership said that 75 percent of the three million cases are concentrated in 12 countries. The Global Fund is supporting projects in all 12 countries, but further work is needed within countries to target and speed up interventions to specific areas that account for gaps in diagnosis and treatment.

Countries implementing the new funding model can reprogram, prioritize and focus on this critical gap of the unreached to change the course of TB. The Global Fund has also set in place a regional initiatives mechanism to fight MDR-TB in the most efficient way. Dr. Ditiu said the new funding model will help countries to invest in interventions that will bear significant impact.

“With the new funding model, it is an opportune time for us – the TB community at large – to strategically invest funding on interventions that will have a significant impact, and make a difference to those suffering from TB and to ensure we reach people that are otherwise not reached,” said Dr. Ditiu.

“This is a significant partnership effort that requests that we really work together in a coordinated, transparent and supportive manner – country representatives, donors, communities, and people affected by TB, researchers, multilateral organizations,” she said.

23 March 2014
Shawn Clackett

Allocations Explained

Issue 40 – 20 March 2014 – Global Fund News Flash

The Global Fund launched full implementation of its new funding model this month, and at its core is a shift from a blanketing “one size fits all” approach to a more targeted approach, so that greater impact can be achieved globally and more people can actually be reached. Many countries that were informed on 12 March about their allocation amount for 2014-2016 are understandably now quite interested to know how those allocation amounts were determined. Many are asking: What was the allocation formula?

The Global Fund has prepared and published an explanation. It’s called “Overview of the Allocation Methodology” and it is pretty comprehensive and detailed. It can be found on the Global Fund website: http://www.theglobalfund.org/en/fundingmodel/allocationprocess/

The Global Fund’s overriding intent is to allocate funds to countries where the burden of HIV, TB and malaria is greatest, and where there is the least ability to pay. The two biggest factors in the allocation methodology, by far, are disease burden and national income level. After that, qualitative factors were taken into consideration, to account for special circumstances in each country due to past program performance, impact, increasing rates of infection, risk, absorptive capacity and other considerations.

The Global Fund is strongly encouraging every country to optimize the use of funding from all sources to see how they can best serve a country’s objectives. Country dialogue is the main vehicle to bring partners together to best decide how to maximize impact. In some countries, where allocation amounts are lower than was expected, there may be critical examination of existing grants, and discussion on how funds need to be shifted or grants reprogrammed. In some cases, there will be difficult choices. In some cases, reprogramming grants can improve support to work more effectively. Those who understand the situation on the ground in each country can decide best.

When the Board of the Global Fund made important decisions about the new funding model, Board members insisted that encouraging ambition be part of the picture, through incentive funding and other means. Some countries have asked how anyone can talk about ambition, when available funds are finite. Yet anyone who looks at HIV, TB and malaria on a global perspective can see that tremendous ambition and innovation and determination are needed to make the progress needed to defeat these diseases. Doing things the same way does not produce significant change. The response to these three diseases has to constantly evolve, to keep up with changes on the ground. To defeat these diseases, we all need to think creatively and aggressively. One tremendous lesson of the past decade is that, when working together, we may be able to achieve significantly more than seems possible today.

18 March 2014
Shawn Clackett

Gender Equality Central to Global Fund’s Next Steps

JAKARTA, Indonesia – The Global Fund is expanding action on gender equality and emphasising the importance of saving the lives of women and girls through increased high-impact, gender-responsive investments to tackle HIV, TB and malaria.

As it observes International Women’s Day, 8 March, the Global Fund cited the health needs of women and girls as a central part of gender equality work that is essential to have significant impact on responses to AIDS, tuberculosis and malaria.

Evidence clearly shows that gender inequalities make women and young girls more vulnerable to acquiring the diseases, and to access care and other services. The latter is particularly true for key affected women, including women living with the diseases and those who are sex workers, who use drugs and who are transgender.

Discussions on gender equality were highlighted at a Board Meeting of the Global Fund that concluded today. Board delegations were briefed on the new Action Plan of the Global Fund Gender Equality Strategy. Women and men from diverse communities in India, Indonesia, Malawi, Myanmar and Zimbabwe spoke of their experiences with the Global Fund and urged leaders to translate words into action.

Over 50 representatives from donor governments, technical agencies and affected women met to determine strategy on concrete steps toward gender equality and to target the world’s health investments towards the populations who need them most.

“We are making progress towards the defeat of these diseases, and greater involvement of women will be key,” said Dr. Nafsiah Mboi, Chair of the Board of the Global Fund and a long-standing gender advocate. “This is an important challenge for all of us. It will require a collective effort from all our partners.”

Women and girls are disproportionately affected by HIV. Gender inequalities increase vulnerability to HIV through violence, including rape. So do unequal power dynamics between women and men, and unequal access to education and economic opportunity. These factors make HIV rates especially high among girls and young women in many countries.

TB is a leading infectious cause of death among women in low and middle-income countries, and can impact fertility as well as create major care and treatment challenges for women and girls. Most malaria cases strike children under five and pregnant women are also particularly vulnerable, because their immunity to the disease is diminished by pregnancy.

In many societies, women do not enjoy the same rights, opportunities and access to services as men. The Global Fund is committed to ensuring its grants support equal and equitable access to prevention, treatment, care and support for all those who need it most, including women and girls in all their diversity. Women’s rights are human rights, making gender equality a cross-cutting concern for all of the Global Fund.

“We have to do more on gender equality,” said Mark Dybul, Executive Director of the Global Fund. “There are many aspects to this work, and one of them is putting women and girls at the center of our health interventions.”

The Global Fund encourages frank, open discussion about gender equality, gender-based violence and sexual and reproductive health rights wherever appropriate. Its new funding model opens a number of opportunities and entry points for strengthened gender equality and for engagement of women affected by the diseases to ensure they are fully involved in dialogues and delivering programs.

Ms Wendy McCarthy AO, Chair of Pacific Friends of the Global Fund

Ms Wendy McCarthy AO, Chair of the Pacific Friends of the Global Fund responds:

It was very pleasing to attend the recent Global Fund meeting and observe that the workshop on gender was oversubscribed. There is a sense that gender has to be center frame and it was wonderful to see the role modelling offered without comment when the Chair and Vice Chair of the Global Fund are female.

Women and girls are disproportionately affected by HIV and their world unravels very quickly. Gender inequalities increase vulnerability to HIV through violence, including rape. So do unequal power dynamics between women and men, and unequal access to education and economic opportunity. These factors make HIV rates especially high among girls and young women in many countries.

At this meeting there was a concerted effort to change these dynamics.

12 March 2014
Shawn Clackett

What’s Behind this Picture?

Global Fund News Flash: Issue 38

What’s Behind this Picture

John Rae is a documentary and commercial photographer who has worked with the Global Fund since 2002 and delivered some of our most memorable images. Over the years, John has visited over 45 countries to document efforts to defeat AIDS, TB and malaria. We asked John to pick a memorable photo and tell us the story behind it. He picked this one, from 2008, and gave this account:

I was in Ciudad del Este, Paraguay, a town defined by its hyperactive cross-border trading with Brazil. Its prisons are full of traders, fixers, and others who have put their toes well over a few legal lines. Prisons are incredibly good incubators of TB because conditions tend to be crowed, dirty, and wet. If you are locked in a crowded cell, it is difficult to protect yourself from infection. I was there to document a successful Global Fund sponsored program that fights the spread of TB at the Ciudad del Este regional prison.

Upon entering, I had to give up my wallet, cell phone, passport, and everything else in my pockets. I met the head of the Stop TB program, Juan Carlos, a handsome ex-inmate who is tall, all muscle, with a scar that runs from behind his left ear to under his chin. His job was to enter cell blocks to check on inmates, look for signs of TB, educate inmates about TB, and to dispense medication. When I asked if I could follow him on his rounds, he looked skeptical. Juan Carlos went deep into the prison – further than any guards would go. I was warned that the guards could not guarantee my safety. With a deep breath I said, “OK, let’s go.” Juan Carlos and I put on white smocks to differentiate ourselves from the prisoners, who wore street clothes.

We walked through a series of gates that puts us beyond the reach of the guards. They followed us part of the way but soon we were on our own. I asked Juan Carlos if he ever had any trouble. He replied that sometimes he gets mugged. But didn’t we leave all our valuables at the guard station? The inmates wear street clothes so anything we are wearing is valuable. Have they taken your shoes? He replies, “Yes.” His shirt? “Yes.” His pants? “Yes.” His underwear? I hold my breath… “Yes.” So, Juan Carlos, what do you do then? He says “I put on a big smile and walk back out.”

But the walk-through was inspiring, not scary. Juan Carlos is a hero to the inmates. They understood that he literally had their life in his hands, as he risked his own. He was greeted with hugs and hoots in many cell blocks. As he spoke to inmates about how they are and whether anyone is coughing, I saw his concern. He checked a couple of guys with TB to see if they were adhering to treatment. I spent two hours walking through the prison. We could have done it in about half the time but Juan Carlos stopped to talk to anyone who needed his attention.

To learn more about John Rae visit: www.raephoto.com

10 March 2014
Shawn Clackett

HIV: Treatment can cut transmission of virus to near zero, says study

“It’s thought that about 50 per cent of new infections come from people who don’t know they are infected”
- Professor Sharon Lewin. Photo: Arsineh Houspian

From the Sydney Morning Harold. Health editor Julia Medew. March 7, 2014

Most HIV-positive people who are on antiretroviral treatment have a near zero chance of transmitting the virus to others during unprotected sex, a European study has found.

In a finding that could dramatically change the lives of HIV-positive people and public health policies in Australia, a study of 282 gay men on treatment with undetectable levels of the virus in their blood, found that none of them transmitted it to their partners through unprotected sex over one year.

While a previous 2010 study of mainly heterosexual couples showed that having an undetectable viral load reduced the risk of transmitting the virus to an HIV-negative partner by 96 per cent, this is the first study to look at the risk in gay men, who make up about 80 per cent of the HIV-positive population in Australia.

HIV experts said that although the latest data presented from the PARTNER study at a US conference this week suggested an ”extremely low and possibly zero risk” of transmission among people with undetectable levels of the virus, it was too early to tell people that they could abandon condoms.

However, they said the study boosted hopes that a strategy of ”treatment as prevention” could play a major role in stemming the spread of HIV in Australia in coming decades and should prompt the federal government to explore more home-based testing so people know their status and can be treated earlier.

Professor Andrew Grulich, of the Kirby Institute, said that while some Australian states including NSW and Victoria had already introduced more rapid HIV testing to encourage people to know their HIV status, Australia should follow the US and allow tests to be sold over the counter in pharmacies for home-based use.

”I think home-based testing absolutely has a place in the testing response in Australia because treatment as prevention critically depends on people with HIV being diagnosed as early as possible, so they know they are infected and can take action to reduce their infectivity before they have any unsafe sex with anybody they could pass it on to,” he said.

Head of infectious diseases at the Alfred Hospital in Melbourne, Professor Sharon Lewin, said a ”treatment as prevention” strategy was promising because about 90 per cent of people on antiretroviral treatment have undetectable levels of the virus in their blood when they have tests, usually at six monthly intervals.

But she said limiting the spread of the virus was complex because about 8000 of the 33,000 people living with HIV in Australia do not know they are infected.

”It’s thought that about 50 per cent of new infections come from people who don’t know they are infected,” Professor Lewin said.

Furthermore, she said only about half of the 25,000 people who know they are HIV positive are receiving antiretroviral treatment for a range of reasons, including a historical requirement for people to show a certain amount of immune system damage to receive subsidised treatment.President of the National Association of People Living with HIV and AIDS Robert Mitchell welcomed the results of the PARTNER study which will continue to examine the risk of transmission among heterosexual and homosexual couples until 2017.

”These results provide further evidence of the powerful impact that HIV treatment has on preventing HIV transmission. It is important that every effort is made to alert people with HIV and their doctors to these latest findings, particularly as this study is the first of its kind to include a significant number of gay couples,” he said.

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Pacific Friends

Wendy McCarthy AO
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Bill Bowtell AO
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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.

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