As usual, the U.S. Global AIDS Coordinator has the numbers to prove it, in Uganda where she says willingness to change is turning daunting numbers downward, and Malawi, where relevant practices are making a difference
VANCOUVER, Canada – “Ending the HIV epidemic as a public health threat” is the stated mission of U.S. Global AIDS Coordinator Deborah Birx and in two years at the helm of the PEPFAR program, she has met the challenge of years of flat investments in PEPFAR with a laser focus on prioritizing services to places and populations that can make the biggest difference in country level goals of epidemic control.
“Broad approaches to program implementation don’t address community level realities,” Birx said in her Monday morning talk to conference delegates in Vancouver.
While highlighting progress in the global AIDS response that has delivered lifesaving treatment to 15 million people in poor countries and decreased deaths from AIDS by 20 percent or more in many of the highest burden countries, she also shared the failures—no progress in reducing AIDS deaths in Mozambique, Nigeria and Cameroon and a 100 percent increase in new HIV infections in Uganda since 2000. “Business as usual,” she warned, would not be sufficient in light of a demographic shift in southern Africa that has delivered a 30 percent increase in young women 10 to 29 years old — the highest risk group on the continent for HIV acquisition. Birx is not about business as usual.
She filled the audience in about the changes she has made in the world’s largest HIV program and the results those changes have delivered. Painstaking analyses of communities and service sites in PEPFAR countries have triggered redeployment of resources to ensure that programs for adults, children and orphans are available where people with HIV live. Dramatic changes in program priorities in Uganda and Cameroon promise more treatment and circumcision services to bring down rates of HIV infections and save more lives. Even with stagnant funding, these are the results Birx anticipates from country plans that have just been finalized
- A 113 percent increase expected in new patients receiving antiretroviral therapy,
- An 11 percent increase in HIV testing targets translating to an additional 10 million persons tested,
- A 25 percent increase in the number of expected circumcisions performed.
Expect more changes to business as usual ahead. Among them — prophylactic access to antiretroviral drugs to prevent transmission — widely known as PreP — for young African women at risk, and new testing approaches to reach the many men who have yet to be diagnosed.