PAHO HIV News. Number 18, December 2009
Americas Pledge to Eliminate Mother-to-Child HIV Transmission and Congenital Syphilis by 2015
During the Fifth Latin American and Caribbean Forum on HIV/AIDS and STI (FORO 2009), health authorities, experts on sexually transmitted infections, and family health professionals launched a commitment to eliminate mother-to-child transmission of HIV and congenital syphilis in Latin America and the Caribbean by the year 2015. The commitment is part of a new Regional Initiative for the Elimination of Mother-to-Child Transmission of HIV and Congenital Syphilis in Latin America and the Caribbean , presented by PAHO, UNICEF, and partner organizations.
The goals of the Initiative are to reduce the mother-to-child transmission of HIV to less than the 2% and the incidence of congenital syphilis to less than 0.5 cases per 1,000 live births by 2015. The Initiative promotes an integrated approach for the prevention of vertical transmission of both diseases. Its programmatic objectives include the strengthening of antenatal coverage, and early diagnosis and treatment for at least 95% of pregnant women in Latin America and the Caribbean . The Initiative also emphasizes the need for strengthening and integrating relevant services into primary health care systems and improving information systems.
HIV infection and syphilis constitute important public health problems in the region. It is estimated that every year more than 6,000 children acquire HIV infection thought mother-to-child transmission, which implies an enormous human, social, and economic cost. At the same time, it is estimated that every year 450,000 cases of gestational syphilis occur in the region. If untreated, 50% to 80% of cases will present serious complications, including pre-term fetal death, peri-natal death or serious neonatal infection.
The Americas Pledge to Eliminate Mother-to-Child HIV Transmission and Congenital Syphilis by 2015 (news release)
http://www.paho.org/eliminationinitiative (website of the Elimination Initiative)
PANCAP, Caribbean Ministers and Stakeholders Endorse Elimination Initiative
Around 120 Caribbean stakeholders endorsed the Initiative for Elimination of Mother-to-Child Transmission of HIV and Congenital Syphilis at the Ninth Annual General Meeting of the PANCAP, in October in Grenada . The PANCAP AGM is the largest regional gathering of national HIV managers, NGOs, CBO's, persons living with HIV, bilateral and multilateral partners, donors, and other stakeholders involved in the Caribbean response to HIV. Dr. Edward Greene, Assistant Secretary General Human and Social Development at the CARICOM Secretariat, welcomed this initiative as a strategy to improve the health and wellbeing of women and children in the Caribbean.
Earlier in September, Ministers of health of the Caribbean expressed their committed to the goals of the Elimination Initiative to have the great majority of children in the subregion free from HIV and syphilis by 2015. The pledge was made during the 18th Meeting of the Caucus of CARICOM Ministers Responsible for Health, in Washington . Dr. Merceline Dahl-Regis, Chief Medical Officer of the Commonwealth of The Bahamas, shared with the Ministers the strategic framework on behalf of the Caribbean Technical Working Group. PAHO's Director, Dr. Mirta Roses Periago, commended the Caribbean for being the first region to publicly and boldly consider the target of elimination of mother-to-child transmission of HIV. Dr. Margaret Chan, WHO Director General, expressed her congratulations to the Ministers of Health for this pioneer effort, and emphasized the need for strengthening maternal and child health services for overall health improvement. Dominica's Minister of Health and the Environment, the Hon. John Fabien, who is responsible to the CARICOM Council for Human and Social Development (COHSOD) for health matters, stated that the Initiative provides several challenges and opportunities to the region's health sector. He pointed out that effective implementation would require political and technical leadership that could only be provided by the participants at the Caucus, the Ministers of Health and Chief Medical Officers of the Region.
More information: CARICOM Health Ministers Launch Regional Initiative HIV Syphilis Free Generations (press release)
http://www.paho.org/eliminationinitiative (website of the Elimination Initiative)
RETOS 2009 Highlight Challenges in Responding to HIV Epidemic in Latin America and the Caribbean
PAHO, UNICEF and UNAIDS launched the publication Challenges raised by the HIV epidemic in Latin America and the Caribbean 2009 (“RETOS 2009”) during the FORO 2009. The report presents an overview of the HIV epidemic in the hemisphere and describes national responses to the epidemic. It emphasizes the daily challenges faced by national HIV programs and health services as they seek to guarantee access to HIV prevention, diagnosis, treatment, care and support to all those who live with HIV in the region. It highlights a number of key challenges to the region's HIV response, including sex work and HIV, prevention of mother-to-child transmission of HIV and congenital syphilis, sexual relations among men who have sex with men, HIV in drug users, access to anti-retroviral treatment, and drug-resistance. The English version of RETOS 2009 will be available soon.
PAHO, UNICEF and UNAIDS highlight challenges in responding to HIV epidemic in Latin America and the Caribbean (press release)
http://www.paho.org/vih/retos (RETOS 2009 report)
Universal Access Report Shows Important Gains in Access to Treatment
More than 4 million people in low-and middle-income countries were receiving ART at the close of 2008. This represents a 36% increase in one year and a ten-fold increase over five years, according to a new report released by the WHO, UNICEF and UNAIDS. Towards Universal Access: Scaling Up Priority HIV/AIDS Interventions in the Health Sector highlights other gains, including expanded HIV testing and counseling and improved access to services to prevent HIV transmission from mother to child. About 445,000 people were receiving ART in Latin America and the Caribbean in 2008, up from 390 000 in 2007, a 14% regional increase. "This report shows tremendous progress in the global HIV/AIDS response," said WHO Director-General Margaret Chan. "But we need to do more. At least 5 million people living with HIV still do not have access to life-prolonging treatment and care. Prevention services fail to reach many in need. Governments and international partners must accelerate their efforts to achieve universal access to treatment."
More information: Press Release
Experts Prepare Plan to Improve Access of MSM to Health Services
Experts in health, governmental authorities, and civil society representatives met in July in Panama to develop a plan to improve the access to health services for men who have sex with men. The "Consultation on Promotion of Health and Service Delivery of Men who Have Sex with Men in Latin America ", convened by PAHO jointly with UNDP and UNAIDS, also identified approaches to reduce stigma and discrimination. Health services often lack personnel with experience in the specific health needs of this population that includes bisexual and homosexual men, as well as men who do not themselves identify as homosexuals but also have sex with men. The consultation was the first meeting of this type in the Americas, and follows the example of the similar events carried out in Europe (Slovenia, May 2008) and Asia (Hong Kong , February 2009). Participants defined a set of essential health services for MSM, which is currently being reviewed, with plans for pilot-testing in a number of countries in 2010. In August, in Mexico, PAHO also brought together a group of experts to propose recommendations for the creation of school environments of respect, inclusion, solidarity, and equity for the purpose of eliminating homophobia, stigma, and discrimination.
Countries of the Americas Promote Sex Education to Prevent HIV (press release)
Summary of the regional consultation
Caribbean Promotes Better Access for HIV-Related Health Services for Most-at-Risk Populations
More than 80 representatives from ministries of health, national HIV programs, and delegates and advocates for vulnerable populations defined regional priorities to increase access to HIV care, treatment and prevention services by the populations most-at-risk to the epidemic. It is well established that certain populations have a greater risk of contracting HIV and as a consequence are disproportionally affected by HIV. In the Caribbean these groups include persons who do sex work, men who have sex with men, transgender, drug users, and incarcerated. Youth and migration are additional factors that compound vulnerability. Most health services in the region are unprepared to provide adequate treatment and care for these groups. The Regional Meeting on Access to HIV Care and Treatment Vulnerable Populations was convened by the Pan American Health Organization (PAHO) and the Caribbean Vulnerable Communities (CVC), a regional civil society organization, with support from other regional groups, Caribbean institutions, and other UN agencies, including UNICEF, UNFPA, and UNAIDS.
More information: Caribbean experts define priorities to increase access to HIV services by vulnerable groups
Translatina Offers a Picture of the Challenges Faced by Transgender Populations
The result of three years of production, more than 100 hours of filming, and interviews with people from 15 nationalities, the documentary Translatina was launched during the FORO 2009. The documentary offers a realistic look at the challenges faced by transgender people in accessing education, work, justice, health care, and other services, but also shows how non-governmental organizations in Latin America are starting a dialogue with governments to demand opportunities for inclusion of transgender people, and how such initiatives may result in significant changes to ensure the rights of the population. PAHO, UNDP and UNAIDS supported the developed of Translatina, an independent production , with the goal of sharing the perspective of civil society organizations and other involved parties on violence and other barriers to health of transgender people. The initiative adds to the efforts to support Resolution 2054 of the OAS, in which the countries of the Americas recognized the problem and expressed their concern about the acts of violence and violation of human rights perpetrated against individuals because of their sexual orientation and gender identity. The few studies conducted in Latin America indicate that the transgender population has been one of the communities hit hardest by the HIV epidemic, with alarmingly prevalence rates. In the last decade the HIV prevalence rate among the transgender population varied from 21.5 percent to 40 percent. The dissemination of the documentary is coordinated by the country offices PAHO, UNDP and UNAIDS, in collaboration with civil society organizations and national authorities.
More information: Translatina
REDLACTRANS Wins Voluntary Service Award
REDLACTRANS, the Latin American and Caribbean Transgender Network, was the 2009 winner of the Clarence H. Moore Award for Voluntary Service, one of five awards granted annually by the Pan American Health and Education Foundation (PAHEF) and by PAHO. REDLACTRANS's 18 national chapters implement several initiatives to increase access of transgender populations to health services. The award ceremony, which took place concurrently with the 49th PAHO Directing Council, brought together ministers of health and ambassadors from PAHO Member States, representatives of the U.S. Congressional Border Caucus and the Congressional Hispanic Caucus, and top-level executives to recognize individuals and organizations who have made outstanding contributions toward improving the health and well-being of the people of the Americas.
PAHEF Press Release
Interview with Marcela Romero
Video of the award ceremony
Regional Adaptation of IMAI Can Help Integration with Primary Care.
IMAI methodology (Integrated Management of Adolescent and Adult Illness), a series of modules and guides developed by WHO and adapted by PAHO, can be an effective tool to integrate the response to HIV with primary health care in Latin America. This was the conclusion of the participants of a meeting in Panama, in October, that brought together representatives of ministries of health, national HIV programs, physicians, primary care physicians, representatives of academic and nursing associations, regional and international agencies, and representatives of civil society of 12 countries. A version of the IMAI modules and guides on care was adapted for the region by Colombian Association of Faculties of Nursing (ACOFAEN) and examined by the participants at the meeting. In LAC, the activities of promotion, prevention, diagnosis, and treatment of HIV are traditionally carried out in specialized centers, which are not integrated within the national health services. This centralization has been effective for the initial rapid scale-up of the response in the majority of countries, but has proven to be ineffective to now expand and maintain the services of promotion, prevention, and diagnosis.
More information: http://www.who.int/hiv/topics/capacity/en/index.html
Report States Progress on Control of TB Co-Infection
The Global TB control 2009 update, launched by WHO in December, showed continued progress on addressing the lethal combination of TB and HIV. Between 2007 and 2008, 1.4 million TB patients were tested for HIV, an increase of 200, 000. Of those who tested HIV positive, one-third benefited from life-saving HIV ART and two-thirds were enrolled on co-trimoxazole prophylaxis to prevent the risk of fatal bacterial infections. In addition, screening for tuberculosis and access to isoniazid preventive therapy for TB among people living with HIV more than doubled, although the total number is still far short of what it should be. The report also indicated that up to 8 million TB deaths have also been averted, confirming DOTS/ the Stop TB Strategy as the most cost-effective approach in the fight against tuberculosis. It is estimated that one in four TB deaths is associated with HIV co-infection. During 2009 PAHO organized two subregional courses in TB/HIV management, in Colombia and Bolivia , with the participation of ten countries, and one course in infection control, with participation seven countries. During 2009 PAHO also disseminated the Guide for Tuberculosis Control in Populations Deprived of Liberty in Latin America and the Caribbean .
Global report 2009 update
Report of the PAHO TB/HIV regional meeting
Report of the IV Regional Meeting of TB and TB/HIV in Penitentiaries
Guide for Tuberculosis Control in Populations Deprived of Liberty in Latin America and the Caribbean
Stop TB Strategy
PAHO Launches Three HIV Databases
PAHO launched three new regional HIV databases: the database on most-at-risk populations and at other vulnerable populations; the database of reported cases of HIV; and the database of reported cases of AIDS. The database on PEMAR and other vulnerable populations contains information on 1,400 studies carried out during two decades in 35 countries of Latin America and the Caribbean .The databases can be used to guide program planning and advocacy, identify gaps in HIV surveillance, improve surveillance studies, and support funding proposals. Visual analysis of LAC MARP Database is available through the PAHO Public Health Intelligence Platform. This platform allows users to view complete sets of visualizations about HIV surveillance studies, zoom in and out, pan across visualizations and print, copy and export images and data to use in applications such as Excel and Power Point. In order to access the visual analysis of new databases users must install Tableau Reader, a no-charge downloadable software.
More information: Surveillance, Monitoring and Evaluation Page
First Anniversary of Ministerial Declaration on Education and Sexual Health Celebrated
The first anniversary of the historical ministerial declaration “Preventing through education” (“Mexico Declaration”) was celebrated on August 1st. The declaration, approved during the First Meeting of Ministers of Health and Education to Stop HIV and STI in Latin America and the Caribbean, carried out in Mexico City , was endorsed by 30 ministers of health and 26 ministers of education, who committed to bringing HIV prevention to the forefront of the response to the epidemic. The goals established and agreed in the Declaration by the ministries of health and education of the Region are: a) by the year 2015, to reduce by 75% the number of schools that do not provide comprehensive sexuality education among schools administered by the Ministries of Education; and b) by the year 2015, to reduce by 50% the number of adolescents and young people who are not covered by health services that appropriately attend to their sexual and reproductive health needs. PAHO provided technical support for the “sexual health promotion” component of the ministerial declaration, and is a member of the intersectoral group (led by Mexico ) that is responsible to support its implementation.
More information (Spanish only):
PAHO press release
Interangency fact sheet about the Mexico Declaration
Statement of the government of Mexico
Text of the declaration
Region Prepares Better to Attract Resources from the Global Fund
The approval of 17 out of the 30 proposals submitted by Latin America and the Caribbean to the Round 9 of the Global Fund reflects a wide ranging effort to improve the performance of the region, to which the UN system also contributed. A consultant training workshop that took place in July in Panama was the most recent activity of a group of agencies and organizations of Latin America and the Caribbean . Integrated by UNAIDS, PAHO, the International Alliance, CSAT, GTZ, CICT and the GCTH, the group aims to increase the coordination and harmonization of technical cooperation and support for the preparation of Global Fund proposals on HIV, tuberculosis, and malaria. The organizations held several meetings and electronic conferences in the recent past, in addition to a workshop on community systems strengthening held in São Paulo, Brazil , in 2008. The purpose of the Panama workshop was to increase the knowledge and skills of a group of technical experts from different fields, so that they can work to support the design, implementation, and evaluation of grants from the GF and other similar programs. In addition, PAHO has created an internal GF working group, with the objective of strengthening national capacities for project design, implementation, follow-up, and monitoring and evaluation of projects addressing the three health conditions and also, to improve health sector plans for HIV, TB and malaria.
Sustainability of the Response Examined by PAHO in Regional ECOSOC Consultation
The financial challenges for a sustained response to HIV were the subject of the presentation made by PAHO's Assistant Director Dr. Socorro Gross in the regional consultation carried out in June, in Jamaica , with the objective of analyzing progress toward the control of the HIV epidemic. The consultation represented the regional contribution to the Economic and Social Council of United Nations (ECOSOC), the main forum for discussion and formulation of recommendations to be submitted to Member States and to the United Nations system. The theme of the meeting this year was the need to respond more effectively to threats posed by the HIV epidemic. The event brought together101 participants representing 22 countries. The participants appealed for strengthening of HIV prevention programs through education and for the increase of investments directed to the epidemic.
More information: 2009 Regional Ministerial Meeting on "HIV and Development in Latin America and the Caribbean"
Up to 33% Price Reduction in ARV Purchased Through Strategic Fund.
PAHO's recent procurement tender for ARV through the Strategic Fund resulted in reductions of 25 % to 33% in the price of certain ARV. Examples of newly reduced prices include Abacavir, (US$ 19.37 for a bottle of 60 tablets of 300 mg) and Efavirenz, (US$ 12.49 for 90 capsules of 200 mg). Other medicines included in the Strategic Fund procurement list are Efavirenz (600 mg), Indinavir (400 mg), Lamivudine (50 mg,10 mg, and 150 mg), Nevirapine Anhydrate (oral 10 mg/ml as well as the 200 mg tablets); Stavudina (30 mg and 40 mg), Zidovudine (300 mg and 100 mg), Zidovudine Syrup (50 mg), and Zidovudine 300 mg + Lamiduvine 150mg. Other antiretrovirals can be purchased through this mechanism, but PAHO is unable to provide the prices with anticipation. PAHO's Strategic Fund reduces the cost of medicines through economies of scale and makes health supplies continuously available. The Fund also encourages planning for use of supplies, promotes quality control procedures in ordering, stimulates acquisition by governments and strengthens Member States' public health programs.
More information: Procurement and supply management
New Recommendations for the Selection of Blood Donors
The PAHO document “Eligibility for Blood Donation” offers several recommendations for the education and the selection of potential blood donors. According to these recommendations,
a donor who has used illegal injecting drugs should be deferred as donor for the next 12 months since the last time he/she has used them. It also states that a person whom engages in unsafe sexual behaviors should be deferred from donating blood for 12 months after the last occurrence of unsafe sex. The blood services should defer for a period of 12 months females offering to donate blood in case their male sexual partners had insertive or receptive anal sex with another male during the previous 12 months. Sexual orientation – heterosexuality, bisexuality, homosexuality – should not be used as criterion for blood donor selection, since it is not a risk by itself. Individuals should not donate blood for a period of six months after having sex with a new partner. Potential blood donors should be encouraged to protect themselves and their partners by practicing safe sex.
More information: Eligibility for Blood Donation: Recommendations for Education and Selection of Prospective Blood Donors.
RED SALUD to Award Best News Articles on Sex Work and Health
Journalists from Chile, Argentina and Colombia won the top three prizes in the Fifth Latin American Health Journalism Awards of Red-Salud ("Health Network") for the articles about sex work and health. The awards—sponsored by PAHO, UNFPA, the Communication Initiative, and the New Ibero-American Journalism Foundation—are designed to motivate Latin American journalists to do more and better reporting on health-related issues. The Latin American and Caribbean Network of Sex Workers helped organize this year 's contest. The top three winners in the "sex work and health" category were chosen from among more than two dozen entries from some of the region 's top newspapers, magazines, and web sites. According to the award organizers, there is no universal model to provide health services to sex workers, but several initiatives can be adopted in order to improve the conditions and promote the well-being of this population group, Those include improving the overall health conditions, the right to reject unsafe practices, protection against violence and harassment, and support for the full enjoyment of civil rights, such as access to optimal health and education, among others. More information: http://new.paho.org/hq/index.php?option=com_content&task=view&id=2018&Itemid=1&lang=en
El Salvador Develops Monitoring System with Support of PAHO
In El Salvador, a joint effort between the National HIV Program and PAHO resulted in the creation of the Unified System of Monitoring, Evaluation, and Epidemiological Surveillance of HIV/AIDS (SUMEVE). A web application that integrates laboratory information, epidemiological surveillance, data on care of patients and prevention activities, the SUMEVE is an essential source of information for the decision-makers. PAHO supported the design and development of the application, which may be implemented in other countries that have shown interest. The SUMEVE can classify the cases as “new”, “existing” and “in monitoring” and to classify confirmed cases by time and place. Users can calculate the incidence by sex, age, origin, occupation, and risk factors. The system allows specific queries on MSM, prisoners, pregnant women, and other populations, making possible to provide information to national and international indicators.
More information (Spanish): Sistema de Monitoreo, Evaluación y Vigilancia Epidemiológica del VIH/SIDA (SUMEVE) en El Salvador
Vaccination Week Incorporates HIV Prevention Activities
The Vaccination Week in the Americas (VWA) held its seventh reoccurrence in May, with an important new development: the incorporation of HIV prevention activities. For the first time the organizers promoted the inclusion of HIV testing and counseling, among other prevention activities in that initiative, which seeks to improve the equity and the access to vaccination.The VWAs started in 2002, as response to a measles outbreak in Venezuela and Colombia. Since then, more than 270 million people have been vaccinated. In the seventh VWA, the emphasis was the vaccination of the family, as well as the vaccination of the health workers. Multiple activities took place in the region, including a series of events in the South American Chaco, a border area shared by Argentina, Bolivia, and Paraguay.For the eighth VWA, PAHO expects to further integrate the vaccination and prevention HIV activities.
More information: Vaccination Week in the Americas
JAIDS Issues Special Edition about HIV in the Americas
The May 2009 edition of JAIDS (Journal of Acquired Immune Deficiency Syndromes) was dedicated to “HIV in the Americas:improving the strategic information in order to improve the response.” The special, free-access edition focuses on strategic information, including epidemiological surveillance and monitoring of sexual behavior, and describes the progress and the challenges for the production, analysis and the use of information in response to the epidemic. Several WHO staff members contributed to the special edition, including PAHO advisers, with an article on the prevention of HIV transmitted by blood transfusion.
More information: http:/journals.lww.com/jaids/toc/2009/05011
PAHO HIV and STI Website has New Address
The PAHO HIV and STI website has a new address and new content, including new sections on treatment guidelines, HIV drug resistance, and TB/HIV co-infection. The surveillance section has a new database on biological studies in populations at greater risk, reported cases of HIV and reported cases of AIDS. The new site also contains sections of multimedia, news, bulletins, and direct links to key themes of the response to HIV, such as the strengthening of health systems, HIV testing and counseling, human rights, young people, and stigma and discrimination.
More information: http://www.paho.org/hiv
List of HIV Frequently-Used Acronyms Updated
PAHO updated its list of HIV-related frequently-used acronyms. The list now contains 121 acronyms, including additions such as MARP (most-at-risk populations), CS (congenital syphilis) and SIP (Perinatal Information System in Spanish).
More information: HIV acronyms most frequently used in LAC
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