Family Planning-A Basic Human Right for Women Everywhere

The Feminist Majority Foundation Intern Hill Briefing on July 24th effectively stressed the importance of saving and improving women’s lives through global family planning.
Craig Lasher, Senior Policy Analyst at Population Action International, began the briefing by reporting a 40% decline in global family planning funding since George W. Bush took office. The year 2008 also marked the seventh straight year Bush has refused to allocate money to the United Nations Population Fund. These actions are part of the so-called “global gag rule” which the president re-instated on his first day in office in January 2001. This heatedly debated and contentious act does not fund foreign NGOs who use any type of funding (US or non-US), to provide safe abortions, abortion counseling, refer women to abortion clinics, or lobby to make abortion legal in their countries. It drastically limits the scope of services provided by international NGOs to women in need, stipulating what they can and cannot do and forcing them to either go without US funding or abide by a strict US controlled agenda. Organizations that do not sign the global gag rule also lose access to heavily relied upon US-donated contraceptive supplies. Crystal Lander, Senior Advocacy Advisor at the Centre for Development and Population Activities, followed up on the global gag rule, commenting that it would be deemed a violation of free speech if applied here in the United States to national NGOs. Lander also made the important clarification that family planning encompasses not only birth control, but HIV/AIDS testing, pap smears, pre and post-natal care, and infant care-all of which are crucial for women’s health.
Ellie Smeal, President of the Feminist Majority Foundation, and Publisher of Ms. Magazine, highlighted the correlation of national and international trends in US family planning policies. Organizations in the US, such as Planned Parenthood, have had to cut back on staff and services provided, and the price of birth control pills has been steadily rising. Smeal appealed to the young age and energy of the audience members by entreating them to realize the equality of all women, everywhere in the world. “There is no difference in the rights of a woman in a developing country and a woman in the United States,” she said. Access to family planning services is a basic health right and should not be denied to anyone. She stressed urgency of action in achieving necessary funding for global family planning, as hundreds of thousands of women every year are dying from maternally related causes, and tens of thousands from unsafe illegal abortions. Smeal also expressed concern over her opinion that the greatest tragedy in this situation, following these un-necessary deaths, is the fact that the US has the resources, knowledge, and sway in the global community to affect positive change on women’s lives both here and abroad, but is not using them. The struggle for equalized family planning must continue until no woman lacks access to a safe birth, contraceptives, infant care, and disease prevention mechanisms.

Date: July 24, 2008
Sponsor: The Feminist Majority Foundation and the Dirksen Senate Office Building
Representative Attending: Emma Gring

Student Luncheon at Africare

On Thursday the 12^th of June, undergraduate students were granted the opportunity to have lunch with the distinguished Mr. Julius Coles to learn about the organization Africare. Mr. Coles, a former senior official with USAID and a graduate of Princeton’s Woodrow Wilson School of Public and International Affairs, has served as the president of Africare since 2002. Africare is the oldest and largest African-American run organization in the field of international development. Its mission is to improve the quality of life for Africans as it partners with communities and African organizations to address three principle areas:

· food security and agriculture

· health and HIV/AIDS

· emergency response

Its grassroots focus is embodied by the philosophy “There are no Africare programs, only African programs.” Currently serving in 25 countries and allocating $50 million annually, Africare has successfully completely over 2,500 development and humanitarian projects in 38 years and delivered over $710 million in aid. With an overhead cost of only 9.1%, Africare receives high ratings from non-profit watchdogs such as American Philanthropy and Charity Navigator. This organization works with all sectors of society as it receives 52% of its funding from the government, significant funding from foundations such as the Gates Foundation, and partners with the Private Sector. Africare has a partnership with Shell in Nigeria to combat Malaria and with Exxon Mobil to promote women’s education in Angola and Chad, just to name a few. Additionally, Africare is a member of the Millennium Water Alliance and works with other NGOs in promoting development and assisting the needs of Africans.

Africare was founded during the Sahelian drought in the early 1970s by Dr. Kirker and his wife as a charity. PeaceCorp Officers Dr. Joseph C. Kennedy and C. Payne Lucas, a former Chairman of UNDP-USA, helped reform the charity and had it incorporated as Africare in May of 1971. The first president of Niger, Hamani Diori, served as a Co-founder and the first Chairman of Africare. From the beginning Africare has exemplified a commitment to partnership between Africans and Americas for the well-being of Africa and her people. Whether Africare workers are engaged in combating HIV/AIDS, helping orphans in a community in Uganda, educating girls in Chad, or participating in microfinance to allow women to have their own businesses, Africare is working to improve the quality of life for Africans with Africans.

Image Source

Sponsor: Africare
Date: June 12, 2008
Time: 12:30-2 pm
Representative Attending: Jessica Walker

Health Systems and the Emerging International Health Architecture

Host: Center for Global Development
Date: January 23, 2008
Speaker: Julian Schweitzer
UNDP-USA Representative: Saphonia Foster

In a discussion concerning health systems and collaborative efforts to improve international health initiatives, the World Bank’s Director of Health, Nutrition and Population, Julian Schweitzer, emphasized the need for horizontal integration. He stated that stakeholders in worldwide healthcare projects including the Gates Foundation, the European Union, the United States Agency for International Development (USAID), and other major global actors would be more effective if they fused their efforts into a simpler, joint system. Major actors such as the World Health Organization, the African Development Bank, and UNICEF, have signed this new inter-agency agreement called the International Health Partnership (IHP).

He stated that the too many fragmented global health organizations undermines the ability actors to relieve some of the world’s most ailing problems. IHP is a step forward to combating this stark reality.

The discussion was framed around, arguably, the most prominent driving force in international development today: the Millennium Development Goals (MDGs). With under-five death rates as a proxy measurement, Schweitzer illustrated that if progress toward the MDGs were to continue at the trends trailing back from 1960, then the world’s poor, including those in Asia, Africa, and other less developed regions, would still be plagued by preventable problems. This travesty calls for change.

In addition to convoluted programs that inhibit efficiency and lack of commitment to the MDGs, unpredictable funding flows also greatly undermine health care program success. To mitigate these setbacks, Schweitzer proposed a re-emphasis to the principles of the Paris Declaration. He noted that a clear shift in mentality where partnership, stable investment, and harmony between the different actors involved in international health issues should approach these problems from a similar mindset where achieving better health systems is the objective. This must include paying service to the priority of strengthening on the ground actors with grants, the potential for growth and innovation, the capacity to improve practices, and increased knowledge. This optimistic plan, the IHP, is possible only with support from a global alliance. This means calls for a commitment in civil society to work toward a stronger collaborative approach in improving health care worldwide.

How PEPFAR is adapting to the Aid Effectiveness Challenge

Featured Speaker: Ambassador Mark R. Dybul, US Global AIDS Coordinator

Date:Monday January 14, 2008

Time:12:00 pm - 2:00 pm

Location:The German Marshall Fund of the United States

UNDP-USA Representative: Saphonia Foster

The German Marshall Fund of the United States hosted an engaging discussion concerning the President's Emergency Plan for AIDS Relief (PEPFAR). Ambassador Mark Dybul, the U.S. Global Coordinator for PEPFAR, presented his thoughts concerning the ideological foundations that this humanitarian program rests on and addressed various issues related to its effectiveness.

Before sparking a discussion on how PEPFAR and other HIV/AIDS prevention programs can be more efficient, Dybul provided a theoretical framework guided by the philosophical principles of the Monetary Consensus and of the Paris Declaration. These documents, he stated, launched principals that direct PEPFAR’s view of how to make humanitarian programs more effective. He touted the new plan and its reflection of these documents ideals which include maintaining good governance in beneficiary nations, having result based program evaluations, encouraging multi-sector cooperation, and ensuring reliable financial support.

During the discussion, the Coordinator encouraged development and health organizations to veer from semantic arguments which often stunt program progress and cost lives as cumbersome debates undermine success. Ironically, this sparked somewhat heated questions about development jargon. Yet despite the contentious definitions, Dybul’s goal of shifting the focus to increasing program efficiency was well received.

Before his audience, which included many ambassadors and embassy delegates from Africa, as well as various representatives from Washington non-profit organizations and think tanks, Dybul made clear the need to change approaches to AIDS relief programs. He encouraged those of PEPFAR and others to pursue relationships of mutual respect with those that health projects target. He suggested that public health officials take a more team-oriented approach to aid programs and to drop the assumption that binary divisions exist in the relationship between the "helpers" and the "helped." This change of perception and a clear vision of what successful progress entails, he claims, are pivotal steps in making AIDS prevention programs more effective.

Date: Monday January 14, 2008

Time: 12:00 pm - 2:00 pm

Location: The German Marshall Fund of the United States, 1744 R St., NW

UNDP-USA Representative: Saphonia Foster

Supporting Parliamentary Leaders to Improve Global Health: Lessons From the Field

Featured Speakers: Hon. Elma Dienda, Namibia and Brionne Dawson, NDI

Hon. Dienda began the presentation with a discussion about her work in Namibia. She explained that lack of commitment from law makers in-country regarding HIV/AIDS makes fighting the pandemic difficult. Women, who have little decision-making power in the household, are especially at risk without laws that protect their rights. Hon. Dienda recommended increasing discussion about HIV/AIDs testing, as well as general education about the disease.

Ms. Dawson discussed the National Democratic Institute’s efforts to work with local governments in order to increase parliamentarian commitment to creating HIV/AIDS laws. Dawson explained that NDI conducted 12 Country Surveys to report what steps legislators in Africa have taken to combat the disease. Through constituent outreach, NDI is working to enhance parliamentary and private sector best practice, which model from arrangements such as De Beer’s free treatment for all employees schema in Namibia.

Sponsor: ICRW in Collaboration with Realizing Rights: The Ethical Globalization Initiative

Location: The Aspen Institute

Date: June 16, 2007

Time: 1-2:30p.m.

Approximate Number of Attendees: 24

Intern Attending: Meredith Blair

Enhancing the Parliamentary Response to the HIV/AIDS Crisis

Featured Speakers: Hon. Pier Ferdinando Casini (Italy), Inter-Parliamentary Union; Hon. Elioda Tumwesigye, Uganda; Hon. Henrietta Bogopane-Zulu, South African National AIDS Council; Rep. Donald Payne, House Subcommittee on Africa and Global Health; Rep. Betty McCollum, Congressional Global Health Caucus; Dr. Pauline Muchina, UNAIDS.

Honorable Pier Ferdinando Casini of Italy, President of the Inter-Parliamentary Union, opened the panel discussion by thanking participants and stressing the continued need for parliamentary leadership in addressing the HIV/AIDs endemic. The panelists emphasized the importance of the parliamentary and congressional roles in creating effective HIV/AIDs response strategies. Panelists also highlighted previous parliamentary accomplishments, such as Uganda’s success in decreasing HIV/AIDs prevalence. Panel participants also discussed the importance of protecting women’s rights as a means of decreasing the spread of HIV/AIDs. Specifically, they suggested parliaments focus on increasing laws that protect and enhance women’s access to education and health care.

Dr. Pauline Muchina, Senior Partnership Advisor of UNAIDS, closed the presentation, echoing fellow panelists with a call for increased parliamentary leadership. Dr. Muchina urged leaders to focus their efforts on attaining greater financial resources so that they may offer more comprehensive response strategies in their countries. Specifically, Dr. Muchina suggested that these response strategies include nutrition programs that will improve the effectiveness for HIV/AIDs treatments.

Sponsor: Inter-Parliamentary Union and the Joint United Programme on HIV/AIDS, in cooperation with the Congressional Human Rights Caucus and the Congressional Global Health Caucus
Location: 2255 Rayburn House Office Building
Date: Tuesday, June 12, 2007 Time: 4:00-6:00PM
Approximate Number of Attendees: 30
Intern Attending: Meredith Blair

Achieving Results in Foreign Assistance- Case Study UNFPA

Event Title: Achieving Results in Foreign Assistance -– Case Study UNFPA
Sponsor: UNFPA
Location: Rayburn Building
Date: Thursday, October 5, 2006
Time: 11am - 1pm
Approximate Number of Attendees: 40
Intern Attending: Kristin Broyhill

Speakers: Myriam Conejo, Huasi Health Center in Ecuador; Gamilah Ghalib Al Sharai, Director of Program and Projects Sector at Al-Saleh Social Foundation for Development in Yemen.

“UNFPA, the United Nations Population Fund, is an international development agency that promotes the right of every woman, man and child to enjoy a life of health and equal opportunity. UNFPA supports countries in using population data for policies and programs to reduce poverty and to ensure that every pregnancy is wanted, every birth is safe, every young person is free of HIV/AIDS, and every girl and woman is treated with dignity and respect.”

Ms. Conejo and Ms. Al Sharai work in their respective countries with organizations supported by the UNFPA which focus on family planning, sexual health and reproductive education. On their journey to New York City, to receive a recognition award for their dedication to and promotion of these important issues, they spoke about their organizations, the obstacles encountered, and the impact of these programs on their societies.

With a growing population in Ecuador, the tradition of dividing land between children to cultivate and live off of is no longer sustainable. Already plots are too small, yet families are forced to support eight to ten children. With over 87 percent of the 60 percent of Ecuadorians who live in poverty being indigenous, the lack of land and high number of children perpetuate and increase poverty levels. To confront this issue, Ms. Conejo, with UNFPA funds, reopened Hausi Health Center, located in a rural area of Ecuador, heavily populated with indigenous persons. The clinic'’s goal is to provide healthcare and treatment to individuals in a manner which combines Western and indigenous medical methods. Reproductive health and education are important aspects of this care. Many families in the community access the health center for family planning services.

Hausi Health Center works with men and women, providing pre and post-natal care, access to contraceptives, reproductive education, STD'’s and family planning. With the typical marriage age being as young as fourteen, Ms. Conejo and her colleagues have also created culturally appropriate sexual education programs for local schools.

The center, built for only a few thousand, has 12,000 patients. Since 1994, with pregnancy health education and family planning promotion, the use of contraceptives among women have increased 30 percent and deaths during childbirth at the clinic have so far this year, for the first time, been at zero.

Hausi faces many difficulties in mainstreaming family planning because of religious and cultural issues. These include the stance of the Catholic Church regarding birth control and the willingness of men to allow their wives to use birth control, fearing their wife will be unfaithful when they migrate for work. Despite these challenges, the Ministry of health has given its support to the clinic and has publicly recognized the importance of family planning services.

In Yemen, Ms. Al Sharai operates a family care center, again with the support of UNFPA, which tackles health problems focusing on prenatal care for women and family planning possibilities. With over half of its population in rural areas, citizens have little or no access to medical services. Since 1982, the organization has raised community awareness among women, men and youth in the areas of family planning, prenatal health and other sexual health issues. Ms. Al Sharai has found that by expanding services to involve men in all stages of family planning, more men have allowed their wives to use contraceptives and more women can access such services without being deterred by traditional stigma.

Although they have faced cultural and religious issues in publicly promoting family planning and reproductive education, religious leaders have stepped up and joined family planning efforts, (based on the statements in the Koran, which states that children must be spaced two years apart for the health of the mother and child) making it an important and publicized issue. Policies have been put in place to allow women who have given birth in the past two years, and girls involved in child marriages, to use contraceptives.

Since 2001, due to allegations that UNFPA is complicit in forced abortions in China, the US Congress, through the Kemp-Kasten Amendment, has withheld over 127 million dollars in funds allocated to UNFPA. In May of 2002, A U.S. State Department fact-finding mission reported, "We find no evidence that UNFPA has knowingly supported or participated in the management of a program of coercive abortion or involuntary sterilization in the People's Republic of China”. The mission recommended the release of $34 million for Fiscal Year 2002.

(Some 160 independent diplomatic and technical monitoring missions have visited UNFPA operations in China and found no involvement in any coercive activity).

The SMARTWork Project: Celebrating and Learning from Five Years of Global HIV/AIDS Workplace Programming

Event Title: Celebrating & Learning from Five Years of Global HIV/AIDS Workplace Programming
Sponsor: Academy for Educational Development (AED)
Location: AED - Academy Hall, 8^th Floor
Date: Tuesday, September 27, 2006
Time: 2:00 p.m. – 4:00 p.m.
Approximate Number of Attendees: 95
Intern Attending: Saadiqa Lundy

Speakers: Deputy Undersecretary Carter; Matthew Roberts, Past Project Director, SMARTWork; Gessy Aubry, Country Coordinator, SMARTWork Haiti; Abiodun Adetoro, Country Coordinator, SMARTWork Nigeria; Natalya Lukanova, Country Coordinator, SMARTWork Ukraine; Patrick Burke, Country Coordinator, SMARTWork Vietnam; Susan Rogers, AED; Paula Church, Kristen Weeks, British Robinson, Victor Barnes.

Today marked the end of the six year long SMARTWork (Strategically Managing AIDS Responses Together in the Work Place) Project. The SMARTWork project was a U.S. government funded initiative which aimed at reducing the number of HIV infected persons, as well as reducing stigmatization and discrimination against those suffering from the disease, through the implementation of policy and workplace programming on HIV/AIDS education and prevention. SMARTWork projects operated in Nigeria, Haiti, Ukraine, Vietnam, the Dominican Republic, and Zimbabwe. SMARTWork Country Coordinators from several sites spoke about their experience with the SMARTWork Project, detailing specific accomplishments, and discussing lessons learned. These presentations were followed by another presentation of overall results, given by Susan Rogers from AED.

The first speaker, Deputy Undersecretary James Carter, spoke about the negative impact HIV/AIDS has had on the labor force. According to Carter, there are 40 million people currently living with HIV and 36.5 million working people infected with the disease. This devastating epidemic is taking a major toll on the most economically productive age group.

The SMART Work Project represented an important step in the global fight against HIV/AIDS. According to past project director Matthew Roberts, bringing labor, business and government together resulted in a strong program. With each sector working together, new HIV/AIDS policies were created and eventually implemented in the workplace. As the four coordinators shared their experience with SMARTWork, they illustrated how coordination between different sectors made success possible. For instance, Gessy Aubry, the SMARTWork coordinator for Haiti, was able to convince a large number of companies to introduce HIV/AIDS education and support programs to the workplace. She noted that it was initially challenging trying to bring together business, government and labor unions, but that it ultimately proved to be a very effective coalition. SMARTWork got everybody to work together to reduce the number of HIV/AIDS cases. As a result, stigmatization has diminished. Aubry concluded by saying that one of the major lessons she learned was that four years was not enough time for her program to fully realize its goals. She suggested that when doing this type of program in a developing county, ten years should be the minimum time projection for project completion.

Mr. Abiodun Adetoro’s experience with SMARTWork was a bit different from that of Ms. Aubry. Mr. Adetoro had two years experience with SMARTWork as the Program Manager in Nigeria. During his short time there, 6,000 workers were tested and he helped to create the 2005 Workplace National Policy on HIV/AIDS in Nigeria.

Ms. Natalya Lukanova, who worked in Ukraine, spent a lot of her time training leaders of trade unions and assisting them in educating others. She discussed the workplace program they created, which provides training to management personnel. Through this program hundreds of employees are educated, and as a result stigmatization is reduced. One lesson Ms. Lukanova learned from her experience was that work needs to be done at all levels; mainly at the national and enterprise level, in order to provide lots of information and services to workers.

The panel discussion ended with a presentation from Susan Rogers about macro-level SMARTWork results. According to Rogers, in Vietnam the government was the driving force of the program, labor was the driving force in Ukraine, and the business sector was the driving force in Haiti and Nigeria. SMARTWork made an impact in the following ways: (1) increased basic knowledge about HIV/AIDS, (2) built a coalition between the business, government and labor sectors to combat the spread of HIV/AIDS and to reduce stigma, (3) implemented prevention programs, (4) provided motivation for targeted behavior change, (5) created permanent support structures to maintain and supplement all of these achievements.

The event concluded with a second panel, which addressed the topic, “Where Do We Go from Here?” The majority of the panelists agreed that targeting the informal sector should be the next step.

For more information about the SMARTWORK Project, please visit www.smartwork.org.

Weaving the Safety Net for Vulnerable Youth Affected by HIV/AIDS in Kenya

Event Title: Weaving the Safety Net for Orphans and Other Vulnerable Children and Youth Affected by HIV/AIDS
Sponsor(s): Interaction
Location: Interaction
Date: September 22, 2006
Time: 10:30 AM - 12:00 PM
Approximate number of Attendees: 20
Intern Attending: Kristin Broyhill

Featured Speaker: Daniel Kinodi from Kenya’s Orphans and Other Vulnerable Children (OVC) Taskforce of the Christian Children’s Fund

Christian Children’s Fund (CCF) in Kenya has taken on a five year project (2005-2010) in conjunction with the Millennium Development Goals to reduce the impact of HIV/AIDS. The project is targeting the 63,325 counted Orphans and Other Vulnerable Children (OVC) in the Kiambu and Thika districts that lie outside of Nairobi. The program’s stated objectives are to strengthen family and community responses in order to provide care and support to OVC’s and to increase the capacity of OVC’s to meet their own psychosocial, educational, vocational training, security, healthcare, protection, food and shelter needs.

The major focus of CCF’s project is training local persons, such as chiefs, teachers and social workers, in relevant legal areas. These include rights of the child, rights of women, rights of those infected with HIV/AIDS, rights of the worker, the making of wills and the Kenyan law of succession. Their training is directed by lawyers and is designed to enable the paralegals to empower themselves, as recognized local leaders, to use law as an instrument for behavior change. The hope is that they can influence communities to discard harmful cultural practices that promote HIV/AIDS, such as widow inheritance and female genital mutilation. Their role in the community is to create legal awareness, assist in cases regarding OVC’s, work closely with home-based care providers, and advise community members on legal matters. Paralegals dedicate their time on a volunteer basis.

Currently, 274 community leaders have been trained as paralegals and 514 children have been trained on child rights. These children are then encouraged to counsel their peers with the knowledge they have acquired.

A number of challenges have presented themselves since the advent of the program. These include inadequate finances, the enormous number of cases, the length of time required to settle abuse cases, inadequate monitoring systems, inadequate legal infrastructure and threats towards the paralegals. In order to overcome these challenges and increase the strength and success of the program, CCF plans to do the following: continue to build strategic partnerships for setting up Child Protection Units, strengthen linkages between the community and the service providers, lobby the government for additional resources and build stronger monitoring systems.

Panel on Innovative Financing for Global Health

July 25, 2006 2:30 – 5:00 PM

Speakers:
Alice Albright, Chief Financial Officer of GAVI
Timothy Evan, Assistant Director-General-Evidence & Information for Policy, World Health Organization
Julio Frenk, Minister of Health, Mexico
Peter Piot, Executive Director of UNAIDS
Moderator: David de Ferranti, Brookings

The event consisted of a panel involved in the global health sector that discussed their opinions on the global health financing gaps and discussed financing solutions that were taking place in the international sector. When looking at the financial aspects of global health, it is important to consider the current flow of money, the offsets, and how that will impact the future.

From the perspective of UNAIDS, voiced by Peter Piot, there have been huge financing leaps for the HIVAIDS programs, however, there has also been widespread transmittance of the disease, so support for combating the epidemic is still seriously under funded. 2001 was a time of remarkable progress for HIV/AIDS relief funding in its ability to tap into global interest to gain a large level of support. In 2005, $8.3 billion was spent on HIV/AIDS programs, but it is imperative that funding continue to increase substantially. The cost of anti-retroviral drugs is a main concern in the future. While the unit price has dropped significantly, immunity to the ARV treatment has developed in patients who are not consistent. Therefore new ARV treatments must be developed, meaning more funding must poor into this. Aids service as part of the health system can be beneficial; the Ryan White Act is an example of this. There is a need for capacity investments, ownership, coherence, and accountability across the health financing spectrum.

Alice Albright discussed the immunization gap in the world, specifically focusing on children’s immunizations. In addressing the gaps, one must look at how to reduce the amount of children without access to vaccinations, narrow discrimination between the numbers of vaccinations that are provided to children, and to increase investment in research and development. Problems in addressing these gaps are availability of funding and consistency of funding. The IFFIM was conceived to address many funding issues, at the moment there are eight world donors who are legally bound for 20 years. The impact of the IFFIM includes new donors, market influence, country planning, and sustainability.

Julio Frenk discussed Mexico’s current health status. Their status has improved due to economic growth and scientific knowledge. Mexico has a rights based approach to healthcare including a new scheme for allocating funds. Mexico has had a 12 fold increase in civil society organizations since 2000. This has led to accelerated universal coverage. Now they are focusing on building healthcare systems with specific priorities. For example, the vertical systems target specific issues, the horizontal systems are good for general health strengthening, and the diagonal heath systems combine the goals of the vertical and horizontal systems. With this, Mexico can focus on research, reform, monitoring, evaluation, scientific excellence, and decision making. Three future suggestions for Mexico’s improved healthcare focus on exchange, evidence, and empathy.

by Rebecca Bonardi

Combating Avian Influenza and HIV/AIDS: Vietnam’s National Policy

July 19, 2006 4:30 PM-6:00 PM

Speakers:
Dr. Trinh Quan Huan, Vice Minister of Health, Vietnam
Dr. Nguyen Huy Nga, Director General, Vietnam Administration of HIV/AIDS Control
Dr. Nguyen Tran Hein, Director, National Institute of Hygiene and Epidemiology

In January 2006, CSIS traveled to Vietnam for an HIV/AIDS Task Force Mission. There have been 108,789 HIV cases nationwide, and by 2010 a predicted 311500 cases of HIV will have been contracted. In 1990 the first case of HIV was reported and in the last five years there has been a rapid explosion of its prevalence. The HIV distribution is gender skewed; 85% of the cases are contracted by males. Of all cases, 70-80% occurs as a result of injection drug use (IDU). Youths are the largest population hit; it is estimated that 50% of HIV infected people are between the ages of 20-29.

The government has adopted a new progressive law that prohibits discrimination and stigmatization of the virus, and includes harm reduction, therapy, care, and support into the treatment plan. Under the wing of PEPFAR, the Vietnam HIV/AIDS program has a strong national strategy that contains an M&E unit, support at every level of society, and a control center. There are programs for women sex workers, for children living with AIDS, and therapy programs for the many injection drug users. The programs are encouraged by the religious centers; Vietnamese monks in particular are especially supportive of the policies and have encouraged their communities to seek treatment and information for prevention.
Vietnam’s main achievements are its political commitment to addressing the HIV/AIDS issue and implementing a strong program. They have scaled up HIV/AIDS treatment and care; as of now 5000 people have access to treatment and by the end of the year, 7000 will. Funding is still the main challenge of the country, right now only 30% of needed funds are available.

The avian influenza is also a major health risk for the country of Vietnam. The epidemic has come in three waves and all provinces of the country have had outbreaks. There have been 92 human cases overall and 42 deaths. There haven’t been any outbreaks in 2006. In wave one, 44 million poultry died. The epidemic started in the northern region of the country, and then jumped to the southern part of the country, skipping the whole middle section. Each wave followed this pattern and the third wave finally migrated to the middle. Wave three was most deadly, and lasted from December 2004 to November 2005.

There were a few major findings reported, the most important being a strong correlation between the river networks and HPAI (human poultry avian influenza) outbreaks. Secondly, the outbreaks occur in the cold wet season (winter/spring). There is no gender discrepancy but the flu seeks more damage among the under 40 crowd. The flu also works in family clusters, meaning that the virus generally would affect more than one family member in a particular region. There is no evidence of human to human transmission of the virus. Direct contact with the ill/dead poultry seven days prior was the main cause of the disease.

Four main ‘lessons learned’ were reported: First, a high level of political commitment is needed, with strong government leadership present. Second, the establishment of multi-sectoral steering committees is needed, and is central to the communal level. Third, good collaboration is needed between the ministries, the government, and the regional and local governments. Organizations and mass media are crucial as well. The implementation by these groups led to surveillance/early warning systems, virus eradication programs, disposal of contaminated birds, a ban of duck hatching, and poultry vaccinations. Finally, the fourth lesson learned was the benefit of a strong health care system that included surveillance, care and treatment across the country. The recommendations for the future include strengthening surveillance, vaccinating poultry, using tamiflu, accelerating human vaccinations, and enhancing regional and global communication.

by Rebecca Bonardi

Sustaining US Global Leadership on HIV/AIDS

July 13, 2006 11:30 AM- 6:00 PM

Welcome: Dr. J. Stephen Morrison, Executive Director, CSIS Task Force on HIV/AIDSCo-chair Address: Senator Bill Frist (R-TN) and Senator Russell Feingold (D-WI)

The CSIS Task Force on HIV/AIDS is co-chaired by Senators Frist and Feingold and funded by the Bill and Melinda Gates Foundation. The task force outlines choices for the US in fighting the HIV/AIDS pandemic. The task force works with US leaders to strengthen country-level capacities to enhance completion, care, and treatment of HIV/AIDS. It its third phase, the task force is focusing on improving US support and effectiveness for global prevention efforts, as well as examining the leadership of the US for future sustainability of the HIV/AIDS programs in place.

In the opening address, Senator Frist emphasized sustainability as the single greatest health challenge of our time. Therefore, it is essential for continued commitment within the US in funding and developing the HIV/AIDS programs. As a country, we have a moral obligation to continue to focus on alleviating the HIV/AIDS crisis and working towards an elimination of the disease. Unity and global health synergy will be vital in the future in slowing the epidemic. One key issue he addressed was the need for clean and safe drinking water worldwide as a necessary part of the health solution. Lack of clean water is the leading cause of preventable death. Water is a foundation for stability that will exponentially improve the health of people around the world and can decrease the effects of AIDS.

Senator Feingold addressed the upcoming challenged in the HIV/AIDS epidemic. The four main challenges are:
1. Prevention: There were 4 million new infections in 2005. The US must expand and reach out to hotspots. Drug use as well as sexual intercourse needs to be of focus. The ABC plan (abstinence, be faithful, condom use) needs to be balanced in spreading the message of correct prevention.
2. Gender: On a global scale, women lack power. When they are less empowered, they have less access to economic opportunities. This is a cause of trafficking which is now one of the main causes of the spread of HIV in particular countries. Rape is also a huge cause of the spread, and the stigma of HIV/AIDS worldwide decreases communication about the consequences and prevention techniques of the disease. The US must institute reproductive health services where PEPFAR is operating, making the program more comprehensive and cost effective.
3. Sustainability of financing: The US must not lose focus and must avoid erosion of finances. The US should mobilize international partners to alleviate costs and increase synergy.
4. Healthcare workforce shortages: In sub-Saharan Africa alone 4 million workers are needed to fill the gap in the healthcare field. This is essential for progress in alleviating the HIV/AIDS epidemic.

Meeting Steep Future Financial Demands
Moderator: Princeton Lyman, Ralph Bunche Senior Fellow for Africa Policy Studies, Council on Foreign Relations
Presenters: Congressman Jim Kolbe (R-AZ)
Congresswoman Betty McCollum (D-MN)
H.E. Ivo Garrido, Mozambican Minister of Health
Jennifer Kates, Director, HIV/AIDS Policy, and Vice President, Henry J. Kaiser Family Foundation
Anil Soni, Director of Pharmaceutical Service, HIV/AIDS Initiative, William j. Clinton Foundation
Discussant: Dr. Michel Kazatchkine, Ambassador on HIV/AIDS and Transmissible Diseases, Government of France

This portion of the conference focused on the financial aspects related to HIV/AIDS.

Congressman Jim Kolbe first spoke, stating that this year 3.4 billion dollars were spent on HIV/AIDS, tuberculosis, and malaria, and in 2007 4 billion dollars will be spent. The global fund for HIV/AIDS has separate funding from the US, the House and Senate will combined be setting aside over 1 billion dollars this year for the fund. The foreign assistance budget continues to grow as well, over the last six years it has doubled. Development is a moral obligation, but the US has to consider the implications of putting funds into foreign assistance when there are domestic priorities.

H.E. Ivo Garrido then gave his input, stating that the fight against HIV/AIDS is complex. Quick results are difficult to achieve. Globally, as the world grows, it is harder to meet goals. Less than 30% of people are reached by prevention programs and less than 25% of people are receiving treatment. Less than 10% of pregnant women are reached. There is not a clear roadmap for the future. The US needs to exercise leadership. There needs to be a focus on moral aspects, increasing development aid, and a focus on prevention, since it goes hand in hand with treatment.

Congresswoman McCollum reiterated the moral obligation the US has to continue sustainability of HIV/AIDS funding. Right now there is a ‘brain drain’ in which nurses from affected areas are drawn to the US for a better life, leaving behind those suffering in their country. The US needs to address this vitally important issue. The job of the US is not to ‘plant flags’ but rather to work in collaboration with the international community.

Jennifer Kates explained how health commitments have risen and donors have changed in the past few years. Now, Europe and the US are equal in health funding. The US needs to look at what money is going into the field and how quickly, and be aware that there are many different financing vehicles, for example UNAIDS and the Global Fund. In 2005, there was 8.3 billion available, but 11.6 billion needed.

Anil Soni first spoke about antiretroviral drug treatments, stating that the cost of treatment for AIDS has gone up, even though the cost of antiretroviral drug treatments has gone down. This is because many people now are moving towards a second line of defense which is accounting a doubling of price increase. To solve this, the US must act early and innovatively, work with industry to understand cost components, and focus also on diseases other than HIV/AIDS.

Michel Kazatckine praises US leadership in the global fight against HIV/AIDS. However, the US should still be focused on increasing ODA (Official Development Aid). The US should also use innovative methods to spend their money and focus on partnerships.

Health Systems Challenges: Workforce & Infrastructure
Moderator: Todd Summers, Senior Policy Officer fro Global Health, Bill and Melinda Gates Foundation
Presenters: Senator Richard Durbin (D-IL)
Dr. Timothy Evans, Assistant Director-General, Evidence and Information for Policy Cluster, WHO
Discussants: Ambassador Jimmy Kolker, Assistant Coordinator, and Director of Diplomatic Outreach, U.S. Global AIDS Coordinator
Brenda Collatrella, Merck & Company

This section focused on some of the problems due to healthcare infrastructure and healthcare worker scarcity.

Senator Durbin addressed some of the persistent healthcare challenges. In the Congo, a main concern is obstetric fistula in young girls, and the ever-present need for nurses. There is a dilemma in the US over focusing on international vs. national healthcare issues, and the correct way to respond to both, alleviating HIV/AIDS and other health problems abroad, while still concerning themselves with the current national health issues.

Dr. Tim Evan spoke of the health workforce. Currently there are 57 crisis countries with a minimum density of workers. Some of this is a result of the young age of retirement. To improve human resources, the US should realize this is an outcomes-based-development era, create leadership for training healthcare workers, and improve technological facilitation.

Jimmy Kolker thought that an innovative way to change the healthcare industry would be to look at the private sector for a cross referral of policies. The US should especially focus of the procedures and guidelines for retired healthcare professionals in tapping resources for training new healthcare leaders.

Brenda Collatrella discussed the HIV/AIDS epidemic in Botswana. There is very little access to treatment; less than 2 million people have been tapped in the past six years. This country needs support financing for a treatment program.

Dr. Mark Dybul gave the keynote address for the conference. He recommended the policy of ‘save and sustain’ by developing capacity and forming partnerships. He focused on country ownerships, the multi-sectoral nature of countries (including governments, private groups, and faith based organizations), good governance, and results. He encouraged reporting and accountability, and response on all levels of society. He recommended task shifting, especially on HIV tests abroad. This could alleviate the healthcare workers scarcity, and make HIV testing more efficient. Using a case study, Dybul gave an example of the positive changes that because of US funding. In Kenya, the prevalence of HIV has dropped by 30% because of increased male faithfulness, a delayed sexual start, and primary and secondary abstinence.

Expanding the Prevention Agenda
Moderator: Jennifer Kates, Director, HIV/AIDS Policy, and Vice President, Kaiser Family Foundation
Presenters: Dr. Nguyen Van Kinh, Head of AIDS Care and Treatment Department, Vietnam Administration of HIV/AIDS Control, Ministry of Health, Vietnam
Dr. Le Truong Giang, deputy Director of the Health Department, Ho Chi Minh City, Vietnam
Janet Fleishchman, Chair, Gender Committee of the CSIS HIV/AIDS Task ForceAllen Moore, Senior Associate, CSIS and Senior Fellow, Global Health Council

This portion of the conference focused on the prevention agenda abroad, using Vietnam as a case study.

Dr. Nguyen Van Kinh overviewed the current status of Vietnam in regards to the HIV/AIDS epidemic. The first AIDS case was reported in 1990, and since then, there have been over 10,000 deaths. Many cases have gone unreported. The greatest occurrence of HIV/AIDS is in young adults aged 20-39, where 75% of cases occur. The biggest cause of the transmission of HIV is through drug injections. 1n 1987 a programs was set up as a preventative measure against HIV under the recommendations set forth by UNAIDS, however that program has since been overwhelmed by the rapid spread of the disease.

Dr. Le Truong Giang gave an expanded overview of the situation in Vietnam, as well as challenges and recommendations. In 1993, the first wave of HIV hit Vietnam, primarily because of sharing needles for opium drug usage. The government responded and there was a decrease. However, since 1996, HIV has been on the rise, with the second wave much more deadly than the first. The wave has hit the younger generation, who are using heroin. The addictive nature of the drug has made it harder for peer-education programs and rehab programs to be effective. Now, the third wave has hit Ho Chi Minh since those participating in the large rehab program have had unsuccessful re-integration into society and drug relapse. A more comprehensive program is needed that covers the city as well as the provinces. PEPFAR should be extended another five years to develop Vietnam’s programs.

Janet Fleischman was the final speaker; she discussed the importance of reproductive health and family planning as a tool to combat HIV/AIDS. These programs can be entry points that will expand communication to women and girls. In Africa, adolescent girls are 5 to 7 times more likely to contract the HIV virus. Mother to child transmission is high, and antenatal care, postnatal care, and family planning are necessary.

Allen Moore briefly discussed PEPFAR and the need for evidence based responses. Aggressive recommendations are needed to increase effectiveness of PEPFAR. The US needs to consider if they are spending too much foreign assistance in the health field. They should also consider if the donor community within the health field is spending too much of its budget on HIV/AIDS instead of other equally important dangerous health viruses.

by Rebecca Bonardi

Youth Speak Out on World Population Day

July 11, 2006 9:30-10:15 AM

Speakers: Sarah Mattison (UNFPA)
Beth Pellettieri (Advocates for Youth)
Maxwell Ciardullo (SIECUS)
Cassie Gardner (Sierra Club)
Jen Stange (Planned Parenthood)

In honor of the UN holiday World Population Day, UNFPA and CCMC sponsored a panel in which young advocates from different organizations centered around issues such as HIV/AIDS, sexual and reproductive health, family planning and the environment. Each panelist discussed what effect population has on each issue.

Sarah Mattison first introduced Beth Pelletieri who spoke about the importance of the world’s youth not only becoming engaged and active in advocating its cause, but also that youth be directly integrated in the policy and decision making process. She also discussed the importance of communication and collaboration amongst different youth organizations in disseminating pertinent information to the public.

Maxwell Ciardullo discussed the importance of educating youth on sexuality as well as the importance of making information available to those who are seeking it by changing current legislation. Ciardullo stated that young people, despite the media’s attempt to indicate otherwise, are not apathetic and need to organize in order to exert their energy, passion and enthusiasm in a productive manner.

Cassie Gardner discussed the link between population and environment and how that relationship affects women. Gardner also spoke about the importance in educating the youth as she stated that the U.S. has the highest rate of teenage pregnancies. Gardner offered three solutions to challenges the world faces regarding population: organize, support the basic human right to be educated and curb one’s own consumption.

Jen Stange also discussed the importance of educating and informing young people on sexuality and reproductive health by stating that the leading cause of death for U.S. girls whose ages range from 15-19 is unplanned pregnancy. Stange stated that it is imperative that legislation be changed and that information and education regarding sexuality must be available at all levels, including in classrooms throughout the world. Stange also denounced the current administration’s approach to preventing HIV/AIDS, which is “abstinence until marriage”, by stating that it ignores many factors that still create risks.

by Megan Shaw

The UN High Level Meeting on HIV/AIDS: A Review and Discussion of Next Steps

Friday, June 16, 2006 9:30 AM – 11:00 AM

Moderator: Ellen Marshall, International Women’s Health Coalition
Speakers: Naina Dhingra, Advocates for Youth
Beri Hull, International Community of Women Living With HIV/AIDS
Michael Kink, Housing Works
Asia Russell, Health GAP

On Friday, June 16th, the UN Foundation sponsored “The UN High Level Meeting on HIV/AIDS: A Review and Discussion of Next Steps.” The event hosted four representatives who actively took part in the UN High Level Meeting on HIV/AIDS which was held over three days in early June. The meeting itself brought together the international community, civil society, NGOs, the government, and the private sector to the UN in New York on to review and discuss the 2001 Declaration of Commitment on HIV/AIDS. Their meeting discussed strategies towards achieving the targets set forth, revised certain implementation strategies in achieving these targets, and renewed political commitment to these goals.
The four representatives reviewing The UN High Level Meeting on HIV/AIDS discussed the accomplishments and shortcomings of the meeting, as well as suggested strategies to continue working towards the goal of achieving universal access both domestically and globally. The main accomplishments that the representatives saw in the meeting were the opportunity that civil society had to impact the political declaration and to force political leaders to seriously address the necessity for universal healthcare. Through lobbying and media publicity, they were able to make some change in what they saw as an inefficient meeting that skirted around the controversial themes of HIV/AIDS, in forms of treatment, prevention, and care. While they all agreed that there was a heightened awareness by the end of the meeting within the political realm in seeing that HIV/AIDS is a huge epidemic that needs to be dealt with in concrete terms, there were still many problems that resulted from the meeting.
The primary issues were in each government representative’s lack of knowledge about the goals of each nation, the rampant spread of HIV/AIDS in each nation, the current state of HIV/AIDS in each nation, and the policies already set forth and agreed upon in the 2001 Declaration. The negotiators often had no background on the HIV/AIDS issue which made it all the more difficult for any new political declaration to be drafted. In the end, the different government had to go line-by-line through the entire political declaration drafted because of the widespread objections to specific clauses and wordings. This resulted in a watered down political declaration, much less impressive than the original 2001 declaration.
The representatives were especially frustrated with the US. The US weakened the document in many instances and their main priorities were in making sure that fiscal targets were not present in the final document and that drug companies would approve. The meeting was politically stratified and the US often allied with Syria and the Vatican on issues concerning prevention and care. This frustrated many of the NGO groups who were disgusted by the political motivations that developed.
The representatives were clear in their perspective that the final document wasn’t bad enough to walk out of, but wasn’t good enough to be pleased about. They did praise the UN for its ability to bring world governments together to address this important issue and in their allowance of civil society to attend the meeting. They were also particularly pleased with Kofi Annan’s presence in demanding a more concrete declaration than the initial draft.

by Rebecca Bonardi

HIV/AIDS in Eurasia: Context, Policy, Research

Thursday, June 8, 2006 3:30 PM – 5:30 PM

Speakers:
Senator Robert Bennett (R-UT)
Craig Calhoun, President, Social Science Research Council
Jennifer Cooke, Co-director, Africa Program, Center for Strategic and International Studies
Robert Heimer, Associate Professor, Division of Epidemiology of Microbial Diseases, Yale University; Director, Connecticut Emerging Infections Program, Yale Office

Senator Bennett’s presentation focused on three core concepts that would alleviate HIV/AIDS in Eurasia. The first step is to facilitate transition to democracy. The second step is to promote the interaction of a free growth economy. The third step is to increase security, including the dismantling of their nuclear capability and decommission of their nuclear weapons.
The second portion of Senator Bennett’s speech focused on the demographic dangers in parts of Eurasia. The trend across Europe is one of a shrinking population, onset by a low birth replacement rate. To sustain a country’s population, the replacement rate must stand at 2.1 births. In Russia and Italy, it is at 1.3, and in Germany it is at 1.7. This danger can be offset by high immigration rates, however there is very little immigrant flow in to the majority of these Eurasian countries, due in large part to a deep ethnic and cultural divide.
Craig Calhoun’s presentation encouraged the exhortation of AIDS statistics to the public in an effort to raise awareness and deepen the sense of urgency in battling this widespread disease. His studies have shown that the AIDS pandemic is less and less a single unified phenomenon as it has spread across the globe. It is not only of a media condition afflicting millions of individuals but a social condition destroying families. The AIDS crisis requires not only urgency and patience but the promotion of a strong relationship between social sciences and public health issues in an effort to mobilize and improve social knowledge and research.
Jennifer Cooke’s presentation focused on her work on the Task Force on HIV/AIDS in Africa. The program was developed before PEPFAR to bring HIV/AIDS to the forefront of political policy. The first phase of the program charted US attitudes to see their willingness in addressing and alleviating AIDS in foreign assistance. The second phase sent senior delegates, influential and well known in foreign affairs, to travel abroad and champion the cause of HIV/AIDS prevention and awareness.
Dr. Robert Heimer’s spoke about his research on HIV transmission among injection users in Russia. The HIV epidemic is up from 1000 to 325,000, in large part because of drug use. He studied the homemade heroin drug chornaya against commercial heroin and found that because of the strong nature chornaya, it actually reduced the spread of HIV in contaminated syringes. His final assessment concluded that homemade drugs are unlikely to have contributed to the spread of HIV in Russia.

by Rebecca Bonardi

Advisory Committee on Voluntary Foreign Aid

June 7, 2006 11:00 AM- 4:30 PM

Keynote: Transformational Diplomacy and U.S. Foreign Assistance
Ambassador Randall L. Tobias, Director of U.S. Foreign Assistance and Administrator, U.S. Agency for International Development

Foreign assistance has obtained its highest profile ever and now is a mainstream strategy and commitment of the US government. The amount of US foreign assistance has tripled since 2001 to 27.5 billion dollars. Secretary Rice has proposed reforming foreign assistance to provide stronger incentives to host countries that will ensure a greater potential in the development of these nations. In doing so, a strategic frameworks is needed that will respond to the needs of its people in these host countries. Nations cannot progress without peace, stability, a just government, human capacity, and economic growth. To strengthen the effectiveness of foreign assistance, countries can be categorized based on shared characteristics and placed on the same path to recovery and stability. US government agencies need join together and integrate foreign assistance planning into the US development program. There is an essential need for these agencies to speak with one voice and align their efforts, so as to increase the responsiveness and effectiveness from government and non-government agencies.

HIV/AIDS: 25 Years Later
Speaker: Dr. Mark Dybul, Acting U.S. Global AIDS Coordinator, U.S. Department of State

2006 marks the 25th year of the discovery of AIDS identification, which has killed twenty-five million people. In 2003, Bush began PEPFAR, the President’s Emergency Plan for Aids Relief. Fifteen billion dollars have gone into this program to combat AIDS in 120 countries over a period of five years. The goals of the plan are to support two million HIV infected people, support care for ten million including orphans and children, and support the prevention of seven million new infections. PEPFAR is working towards seeking an AIDS free generation that is being instigated by the research of global vaccinations.
PEPFAR encourages the involvement of local organizations in developing and sustaining programs, in doing so it holds a culture of accountability in the world. Community participation creates higher result rates that targets specific issues and allows for an independent response based on cultural norms and lifestyles. The programs implemented are encouraged to be evidence based ones; for instance the ABC program is a preventative program encouraging behavior change (abstinence, be faithful, condom usage). The focus of these programs is some combination of prevention, care, and treatment.

The New Partner Initiative
Patrick Purtill, Director, New Partner Initiative, Office of the U.S. Global AIDS Coordinator, U.S. Department of State
The New Partner Initiative, a program targeting NGO’s, is designed to increase the amount of action towards the AIDS epidemic. Its goal is to increase the emergency plan’s ability to reach people with needed services and to build capacity in host nations. The objectives for NGO’s developing programs are prevention, testing, care of orphans and children, and those with AIDS and HIV. To apply for the program, go to pepfarmpi.gov.

Challenges Ahead in the HIV and AIDS Epidemic
Dr. Tim Flanigan, ACVFA Member and Chief, Division of Infectious Diseases, Department of Medicine, Brown University
In dealing with the AIDS epidemic, there is a need for synergy between treatment and prevention. Treating HIV at its onset is the backbone of prevention for AIDS. A future goal in dealing with AIDS to incorporate families into prevention and intervention as well as linking AIDS care to TB care, a co-occurring epidemic. New programs being developed to combat AIDS include couples testing, routine testing, and community based testing using rapid-oral-testing.

Impact on Development and Lessons Learned from PEPFAR Grantees
Panelists: Emily Chambers (Youth HIV/AIDS Programs Manager, Samaritan’s Purse), Steve Moseley (ACVFA Member, and President and CEO, Academy for Educational Development), William Reese (ACVFA Member, and President and CEO, International Youth Foundation)
Emily Chambers, who works with youth across Africa, discussed the need for community ownership of programs that could reach out to their members more effectively than foreign programs that perhaps wouldn’t understand local customs as well. The stigma of the disease could fade by discussions within community and awareness. She developed programs that taught youth about healthy choices and created a sense of normalcy in getting tested as a preventative measure against AIDS. The program decreases the stigma associated with HIV/AIDS.
Steve Moseley’s approach to the AIDS epidemic has also been to focus on communities and the support that lies within. He seeks to mobilize effective communities, increase support for programs in local schools, and implement voluntary testing programs. William Reese’s approach to HIV/AIDS is through the prevention of the spread of AIDS. He works through schools to change the behavior of youth and to promote life skills among those infected. He sees basic ignorance about the disease as a main factor in the spread of the disease and seeks to combat this by educational programs abroad.

by Rebecca Bonardi