16 March 2016
Shawn Clackett

PEPFAR: Is 90-90-90 Magical Thinking?

The Lancet
By Scott Barnhart
March 2016

The world is too complicated for disease-specific approaches to health, as the ravages of Ebola in weak health systems have shown. A health-system strengthening approach will ensure that, especially in times of austerity, there are local institutions and infrastructure in place to provide care for all.


The President’s Emergency Plan for AIDS Relief (PEPFAR) 3.0 has embarked on an important refocusing to achieve epidemic control through 90-90-90 (90% of HIV-positive individuals knowing their status, 90% of those receiving antiretroviral therapy, and 90% of those achieving viral suppression).1 and 2 Despite good intentions, the implementation is creating health-system disruption. For example, in Zimbabwe, a voluntary medical male circumcision programme will now serve ten instead of 21 districts. Ambassador Birx, referring to these programme cuts as “efficiencies”, touted that funds will be freed up “for the greatest impact.3” Although this might optimise impact in areas of the highest HIV/AIDS burden, medical sites are being triaged, with patients losing services and investments being wasted. Concentration on fewer districts also leads to poaching of health workers from already understaffed sites elsewhere.

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9 March 2016
Shawn Clackett

Creating Opportunity for Women

On International Women’s Day, 8 March, we mark progress in the fight for gender equality, and we face a reality that is still starkly unjust. Today, 62 million girls are still denied the right to education, half a billion women cannot read and 155 countries still have laws that discriminate against women.

That is unacceptable, and we must work together to change it. In a report entitled “Poverty is Sexist,” published by ONE, leaders in global development call on the world to act on gender inequality and create more opportunity for women.

Gender inequality often leaves women and girls prone to diseases and other life-threatening conditions. Adolescent girls and young women are disproportionately affected by HIV. Currently, more than 7,000 young women and girls are getting infected with HIV every week.

We must address social factors that put adolescent girls and young women at increased risk for infectious diseases, and provide them with more opportunities in life. Education can make a transformative difference, and keeping girls in school can create a solid foundation for better choices on building a career, owning property, and deciding whether and when to marry and have children. We must strive for a world where human beings, no matter their gender, can live a successful and healthy life.

5 March 2016
Shawn Clackett

Studies Probe Retention in HIV Care for Mothers

On 22 March 2013 in Lilongwe, the capital of Malawi, Posha Ndelemani, who is living with HIV, holds her infant son while seated on a cot. On 20 March, she gave birth via caesarean section after the infant was found to be in a breech position in utero. Ms. Ndelemani participates in the Option B+ programme, which provides a once-daily antiretroviral tablet to prevent the transmission of HIV from mother to infant during pregnancy, birth and breastfeeding. Option B+ was developed by the Ministry of Health in collaboration with UNICEF and other partners.

By Carole Leach-Lemens

Engaging lay counsellors to provide a combination package of evidence-based interventions in Nyanza, Kenya and addressing partner disclosure, as well as pre-treatment education about the benefits of antiretroviral therapy (ART) for maternal and child health in Malawi’s Option B+ programme, improved retention in care and reduced loss to follow-up of mothers with HIV and their infants, studies presented last week at the Conference on Retroviruses and Opportunistic Infections (CROI 2016) in Boston show.

Poor retention in care of mothers with HIV and their infants across the prevention of mother-to-child transmission (PMTCT)/paediatric care continuum continues to undermine what is otherwise a remarkable success. If retention is not adequately addressed, programme success and maternal and infant health are threatened. In resource-poor settings, studies have shown 17% of pregnant women with HIV initiated on ART do not return after their first antenatal care visit; one third of women with HIV who give birth in a clinic are lost to follow-up three months after delivery.

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3 March 2016
Shawn Clackett

How Gut Microbiota Impacts HIV Disease


Scientific American
By Bob Roehr
01 March 2016

A new understanding of the role gut microbiota plays in HIV disease is beginning to emerge, suggesting potential new strategies to manage the infection

HIV is a disease of the gut, a concept that’s easy to lose sight of with all the attention paid to sexual transmission and blood measurements of the virus and the CD4+ T cells it infects and kills. But the bottom line is that about two thirds of all T cells reside in the lymphoid tissue of the gut, where the virus spreads after exposure, even before it shows up in blood. Blood, however, has been the focus of research and care because it is easy to sample and broadly represents what is going on throughout the entire body.

The gut is a lot harder to access, which is why much of it remains a crudely delineated terrain that can only be examined with blunt and invasive tools. But a better understanding of the gut environment will be necessary to achieve the next level of advances in comprehending the disease and fashioning better interventions, researchers said last Wednesday at the annual Conference on Retroviruses and Opportunistic Infections in Boston. “Why do we care about the microbiome?” asked Nichole Klatt, a University of Washington (U.W.) pathobiologist, whose lab focuses on mucosal immunology. Klatt, who organized and chaired the conference session, answered her own rhetorical question, summarizing that HIV infection decreases the number and diversity of beneficial bacteria and increases those that have negative effects on the gut.

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25 February 2016
Shawn Clackett

Global Fund Congratulates India on Launch of Malaria Elimination Framework

NEW DELHI – The Global Fund to Fight AIDS, Tuberculosis and Malaria praised India’s leadership and vision for launching an ambitious national framework to eliminate malaria by 2030, and called the country’s significant progress against the disease an example in global health

With the support of many partners, India has seen a dramatic decline in malaria rates and malaria deaths. Through combined interventions that include rapid diagnostic tests, artemisinin-based combination therapy, long-lasting insecticidal nets and indoor residual spraying, India is projected to achieve a fall in case incidence of 50-75 percent between 2000 and 2015

“India is showing others that with commitment, partnership and innovative strategies we can eliminate malaria,” Mark Dybul, Executive Director of the Global Fund, said during the presentation of the National Framework for Malaria Elimination in India 2016-2030 and the Operational Guidelines for Malaria Elimination in India. “This framework is a hugely important step that gets us closer towards that goal.

J.P. Nadda, Minister of Health and Family Welfare of India, stressed his country’s engagement to eliminate the disease.

“I can only assure you that the Government of India fully stands committed to the malaria elimination program, with the support of all stakeholders,” said Nadda.

During a two-day meeting that brought together the Government of India, WHO, academics and the Indian and global public health sector, partners discussed strategies and implementation of the framework, innovation and research, health system strengthening, and shared experiences for malaria elimination.

Under the framework, India aims to eliminate malaria (zero indigenous cases) throughout the entire country by 2030, and maintain malaria-free status in areas where malaria transmission has been interrupted and prevent re-introduction of malaria. Elimination will be undertaken in a phased manner, with states with low incidence rates first, followed by the high-incidence ones.

The framework is in line with the Asia Pacific Leaders’ Malaria Alliance Malaria Elimination Roadmap for 2030.

India’s commitment to regional malaria elimination is timely. Emerging drug resistance in the Greater Mekong region is threatening the progress made toward elimination. Resistance to artemisinin – the most commonly used drug worldwide against malaria – has been detected in Myanmar, Thailand, Viet Nam, Laos and Cambodia.

Pacific Friends operates as a program within the Kirby Institute at the University of New South Wales.

Pacific Friends

Professor Janice Reid AC
Bill Bowtell AO
Executive Director

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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